A Less Than Honest Policy

By BOB HERBERT, NY Times, December 29, 2009

There is a middle-class tax time bomb ticking in the Senate’s version of President Obama’s effort to reform health care.

The bill that passed the Senate with such fanfare on Christmas Eve would impose a confiscatory 40 percent excise tax on so-called Cadillac health plans, which are popularly viewed as over-the-top plans held only by the very wealthy. In fact, it’s a tax that in a few years will hammer millions of middle-class policyholders, forcing them to scale back their access to medical care.

Which is exactly what the tax is designed to do.

The tax would kick in on plans exceeding $23,000 annually for family coverage and $8,500 for individuals, starting in 2013. In the first year it would affect relatively few people in the middle class. But because of the steadily rising costs of health care in the U.S., more and more plans would reach the taxation threshold each year.

Within three years of its implementation, according to the Congressional Budget Office, the tax would apply to nearly 20 percent of all workers with employer-provided health coverage in the country, affecting some 31 million people. Within six years, according to Congress’s Joint Committee on Taxation, the tax would reach a fifth of all households earning between $50,000 and $75,000 annually. Those families can hardly be considered very wealthy.

Proponents say the tax will raise nearly $150 billion over 10 years, but there’s a catch. It’s not expected to raise this money directly. The dirty little secret behind this onerous tax is that no one expects very many people to pay it. The idea is that rather than fork over 40 percent in taxes on the amount by which policies exceed the threshold, employers (and individuals who purchase health insurance on their own) will have little choice but to ratchet down the quality of their health plans.

These lower-value plans would have higher out-of-pocket costs, thus increasing the very things that are so maddening to so many policyholders right now: higher and higher co-payments, soaring deductibles and so forth. Some of the benefits of higher-end policies can be expected in many cases to go by the boards: dental and vision care, for example, and expensive mental health coverage.

Proponents say this is a terrific way to hold down health care costs. If policyholders have to pay more out of their own pockets, they will be more careful — that is to say, more reluctant — to access health services. On the other hand, people with very serious illnesses will be saddled with much higher out-of-pocket costs. And a reluctance to seek treatment for something that might seem relatively minor at first could well have terrible (and terribly expensive) consequences in the long run.

If even the plan’s proponents do not expect policyholders to pay the tax, how will it raise $150 billion in a decade? Great question.

We all remember learning in school about the suspension of disbelief. This part of the Senate’s health benefits taxation scheme requires a monumental suspension of disbelief. According to the Joint Committee on Taxation, less than 18 percent of the revenue will come from the tax itself. The rest of the $150 billion, more than 82 percent of it, will come from the income taxes paid by workers who have been given pay raises by employers who will have voluntarily handed over the money they saved by offering their employees less valuable health insurance plans.

Can you believe it?

I asked Richard Trumka, president of the A.F.L.-C.I.O., about this. (Labor unions are outraged at the very thought of a health benefits tax.) I had to wait for him to stop laughing to get his answer. “If you believe that,” he said, “I have some oceanfront property in southwestern Pennsylvania that I will sell you at a great price.”

A survey of business executives by Mercer, a human resources consulting firm, found that only 16 percent of respondents said they would convert the savings from a reduction in health benefits into higher wages for employees. Yet proponents of the tax are holding steadfast to the belief that nearly all would do so.

“In the real world, companies cut costs and they pocket the money,” said Larry Cohen, president of the Communications Workers of America and a leader of the opposition to the tax. “Executives tell the shareholders: ‘Hey, higher profits without any revenue growth. Great!’ ”

The tax on health benefits is being sold to the public dishonestly as something that will affect only the rich, and it makes a mockery of President Obama’s repeated pledge that if you like the health coverage you have now, you can keep it.

Those who believe this is a good idea should at least have the courage to be straight about it with the American people.

Lee Feldman, "On the Moon"

TimeOut New York

Feldman's poignant and occasionally disquieting vignettes mine complex truths, finding romance and heartbreak in the mundane details and rituals of daily life... a winner in any year.

CMJ Online

Keep in mind how long it took for people to figure out the greatness of Tom Waits and Randy Newman, and keep your eye on Lee.

Debate Shows Obama Plays by Washington’s Rules

By ADAM NAGOURNEY, NY Times, December 26, 2009

WASHINGTON — Howard Dean ran for president in 2004 as the outsider ready to battle an entrenched establishment in Washington. And so, four years later, did Barack Obama.

Now, one year into Mr. Obama’s presidency, a sharp dispute between the president and Mr. Dean over the health care bill the Senate approved Thursday — Mr. Dean denounced it as a sellout, while Mr. Obama heralded it as a historic breakthrough — is illustrating the roots of the ideological breach within the Democratic party.

It is not just that the left wing of the party thinks that its centrists hold too much sway and are too quick to cave when faced with pressure from the right. It is also that this White House, stocked as it is with insiders, people whose view of politics is shaped by the compromises inherent in legislating, is confronting a liberal base made up largely of outsiders to the lawmaking process who are asking why they should accept politics as usual.

As much as Mr. Obama presented himself as an outsider during his campaign, a lesson of this battle is that this is a president who would rather work within the system than seek to upend it. He is not the ideologue ready to stage a symbolic fight that could end in defeat; he is a former senator comfortable in dealing with the arcane rules of the Senate and prepared to accept compromise in search of a larger goal. For the most part, Democrats on Capitol Hill have stuck with him.

By contrast, Mr. Dean, the former Democratic Party chairman who has long had strained relations with this administration, said the White House was slow to fight and quick to make concessions — particularly on creating a public insurance plan — and demanded that Democrats kill the Senate version of the health care bill.

That sentiment was echoed by liberal efforts that grew up around the Dean campaign, notably Daily Kos and MoveOn.org, which argued that Mr. Obama was not tough enough in staring down foes, be they insurance companies or Senator Joseph I. Lieberman, the Democrat-turned-independent from Connecticut.

“He ran as someone who would fight against entrenched special interests on behalf of the little guy,” said Adam Green, co-founder of the Progressive Change Campaign Committee, which has emerged as one of Mr. Obama’s leading critics in recent days. “And what we learned in this debate is that he’s not willing to fight and exert pressure on entrenched special interests when it comes to big ideas.”

Of course, it is easier to be an outsider when you are on the outside, which is where Mr. Dean is these days, after making an unsuccessful effort to win a post in the Obama White House. And Mr. Dean’s longtime feud with Rahm Emanuel, the White House chief of staff, was noted by many Democrats who were taken aback by the sharp tenor of Mr. Dean’s attack on others in the party. (Mr. Dean declined to comment.)

Still, Mr. Obama’s approach to this battle should not be a surprise to anyone who has followed his career or his campaign for the White House. He served in the United States Senate and in the Illinois Senate. His choice for chief of staff — Mr. Emanuel — was the No. 3 person in the House Democratic leadership, and many of his top West Wing aides came out of staff jobs in the Senate.

Mr. Obama may find it frustrating that it is impossible under Senate rules to get something through without 60 votes, but those are the rules and he is going to play by them. He was not about to go to Connecticut and to whip up the public against Mr. Lieberman, or to press for him to be relieved of his leadership positions in the Senate, as Mr. Green suggested he do.

“The president wasn’t after a Pyrrhic victory — he wasn’t into symbolism,” said David Axelrod, a senior adviser to Mr. Obama. “The president is after solving a problem that has bedeviled a country and countless families for generations.”

All of this has come at a time of strains between Mr. Obama and the left. Mr. Obama has come under fire on several fronts, like health care, escalation of the war in Afghanistan and his failure so far to make good on a campaign pledge to end the ban on open homosexuals in the military.

Mr. Obama has moved to the center on some issues since he became president, particularly on elements of national security. Still, he never presented himself as a doctrinaire liberal, and much of what he is doing as president tracks with what he talked about during the campaign.

Mr. Obama’s call to send more troops to Afghanistan is what he always talked about in the context of outlining his opposition to the war in Iraq. “It’s not like he woke up one morning and said, ‘Let’s go fight a war in Afghanistan,’ ” Mr. Emanuel said. “He talked about it in the campaign.”

And Mr. Obama never exhibited the left’s passion for establishing a public insurance option as part of an overhaul of health care. He rarely talked about it during scores of debates, speeches and interviews during the campaign; instead he focused on expanding coverage, lowering costs and ending health insurance abuses.

During the campaign, many people saw in Mr. Obama what they wanted to see in him, and in the Democratic primaries he often appealed more directly to the left than did Hillary Rodham Clinton, his main rival for most of the contest. The question now is whether legislative and policy accomplishment — signing a health care bill, however imperfect in the eyes of liberals, steadying the economy, winding down the war in Iraq — will be enough, assuming Mr. Obama achieves them, to maintain the support and enthusiasm of those on the left who wanted even more from him.

Mr. Green said that Mr. Obama’s failure to push for the public option — or to enlist his network of grass-root supporters behind it — had sapped the energy out of the base and would have consequences for the 2010 elections. If Mr. Green is correct, that could be a real problem for Democrats, particularly given how energetic opposition to the health bill and the entire Obama agenda appears to be among Republicans.

But this could also prove to be a test of just how much power the outside voices in the left wing have over the insiders in the White House and on Capitol Hill. The stinging attack from Mr. Dean and organizations on the left calling for the defeat of the health care bill failed to dissuade a single Senate Democrat from voting for it. And Mr. Axelrod said he was not worried that would hurt the party come November.

“When people focus on what this bill is and not what it isn’t and recognize what an enormous landmark achievement it is, progressive achievement, you’ll see folks rallying around this and not running away from it,” he said.

The Obama Way

By ROSS DOUTHAT, NY Times, December 26, 2009

Every presidency is the subject of competing caricatures. But almost a year into his first term, there’s something particularly elusive about Barack Obama’s political identity. He’s a bipartisan bridge-builder — unless he’s a polarizing ideologue. He’s a crypto-Marxist radical — except when he’s a pawn of corporate interests. He’s a post-American utopian — or else he’s a willing tool of the national security state.

The press has churned out a new theory every week, comparing Obama to John F. Kennedy and Franklin Roosevelt, to George H. W. Bush and Jimmy Carter — to every 20th-century chief executive, it often seems, save poor, dull Gerald Ford. But none of the analogies have stuck. We’re well into the Obama era, but neither his allies nor his enemies can quite get a fix on exactly what our 44th president really represents.

Obama baffles observers, I suspect, because he’s an ideologue and a pragmatist all at once. He’s a doctrinaire liberal who’s always willing to cut a deal and grab for half the loaf. He has the policy preferences of a progressive blogger, but the governing style of a seasoned Beltway wheeler-dealer.

This is a puzzling combination, for many, because we expect our politicians’ principles to align more neatly with their approach to governing. Our deal-making Machiavels are supposed to be self-conscious “centrists” (think Ben Nelson or Arlen Specter). Our ideological liberals and conservatives are supposed to be more concerned with being right than with being ruthlessly effective.

It’s also puzzling because Obama promised exactly the opposite approach while running for the presidency. He campaigned as a postpartisan healer who would change the cynical ways of Washington — as a foe of both back-room deals and ideology-as-usual. But he’s governed as a conventional liberal who believes in the existing system, knows how to work it and accepts the limitations it imposes on him.

In hindsight, the most prescient sentence penned during the presidential campaign belongs to Ryan Lizza of The New Yorker. “Perhaps the greatest misconception about Barack Obama,” he wrote in July 2008, “is that he is some sort of anti-establishment revolutionary. Rather, every stage of his political career has been marked by an eagerness to accommodate himself to existing institutions rather than tear them down or replace them.”

Both right and left have had trouble processing Obama’s institutionalism. Conservatives have exaggerated his liberal instincts into radicalism, ignoring the fact that a president who takes advice from Lawrence Summers and Robert Gates probably isn’t a closet Marxist-Leninist. The left has been frustrated, again and again, by the gulf between Obama’s professed principles and the compromises that he’s willing to accept, and some liberals have become convinced that he isn’t one of them at all.

They’re wrong. Absent political constraints, Obama would probably side with the liberal line on almost every issue. It’s just that he’s more acutely conscious of the limits of his powers and less willing to start fights that he might lose than many supporters would prefer. In this regard, he most resembles Ronald Reagan and Edward Kennedy. Both were highly ideological politicians who trained themselves to work within the system. Both preferred cutting deals to walking away from the negotiating table.

The upside of this approach is obvious: It gets things done. Between the stimulus package, the pending health care bill and a new raft of financial regulations, Obama will soon be able to claim more major legislative accomplishments than any Democrat since Lyndon Johnson.

The downside, though, is that sometimes what gets done isn’t worth doing. The assumption that a compromised victory is better than no victory at all can produce phony achievements — like last week’s “global agreement” on climate change — and bloated, ugly legislation. And using cynical means to progressive ends (think of the pork-laden stimulus bill or the frantic vote-buying that preceded this week’s Senate health care votes) tends to confirm independent voters’ worst fears about liberal government: that it’s a racket rigged to benefit privileged insiders and a corrupt marketplace floated by our tax dollars.

At the same time, Obama doesn’t enjoy the kind of deep credibility with his base that both Reagan and Kennedy spent decades building. When Kennedy told liberals that a given compromise was the best they could get, they believed him. Whether the issue is health care or Afghanistan, Obama’s word doesn’t carry the same weight.

This leaves him walking a fine line. If Obama’s presidency succeeds, it will be a testament to what ideology tempered by institutionalism can accomplish. But his political approach leaves him in constant danger of losing center and left alike — of being dismissed by independents as another tax-and-spender, and disdained by liberals as a sellout.

White House as helpless victim on healthcare

Nonsense. The administration is getting the bill that it -- more or less -- wanted all along The evidence was overwhelming from the start that the White House was not only indifferent, but opposed, to the provisions most important to progressives. The administration is getting the bill which they, more or less, wanted from the start -- the one that is a huge boon to the health insurance and pharmaceutical industry. And kudos to Russ Feingold for saying so:

Glenn Greenwald

Dec. 16, 2009

(Updated below - Update II - Update III - Update IV - Update V)

Of all the posts I wrote this year, the one that produced the most vociferious email backlash -- easily -- was this one from August, which examined substantial evidence showing that, contrary to Obama's occasional public statements in support of a public option, the White House clearly intended from the start that the final health care reform bill would contain no such provision and was actively and privately participating in efforts to shape a final bill without it. From the start, assuaging the health insurance and pharmaceutical industries was a central preoccupation of the White House -- hence the deal negotiated in strict secrecy with Pharma to ban bulk price negotiations and drug reimportation, a blatant violation of both Obama's campaign positions on those issues and his promise to conduct all negotiations out in the open (on C-SPAN). Indeed, Democrats led the way yesterday in killing drug re-importation, which they endlessly claimed to support back when they couldn't pass it. The administration wants not only to prevent industry money from funding an anti-health-care-reform campaign, but also wants to ensure that the Democratic Party -- rather than the GOP -- will continue to be the prime recipient of industry largesse.

As was painfully predictable all along, the final bill will not have any form of public option, nor will it include the wildly popular expansion of Medicare coverage. Obama supporters are eager to depict the White House as nothing more than a helpless victim in all of this -- the President so deeply wanted a more progressive bill but was sadly thwarted in his noble efforts by those inhumane, corrupt Congressional "centrists." Right. The evidence was overwhelming from the start that the White House was not only indifferent, but opposed, to the provisions most important to progressives. The administration is getting the bill which they, more or less, wanted from the start -- the one that is a huge boon to the health insurance and pharmaceutical industry. And kudos to Russ Feingold for saying so:

Sen. Russ Feingold (D-Wis.), among the most vocal supporters of the public option, said it would be unfair to blame Lieberman for its apparent demise. Feingold said that responsibility ultimately rests with President Barack Obama and he could have insisted on a higher standard for the legislation.

"This bill appears to be legislation that the president wanted in the first place, so I don’t think focusing it on Lieberman really hits the truth," said Feingold. "I think they could have been higher. I certainly think a stronger bill would have been better in every respect."

Let's repeat that: "This bill appears to be legislation that the president wanted in the first place." Indeed it does. There are rational, practical reasons why that might be so. If you're interested in preserving and expanding political power, then, all other things being equal, it's better to have the pharmaceutical and health insurance industry on your side than opposed to you. Or perhaps they calculated from the start that this was the best bill they could get. The wisdom of that rationale can be debated, but depicting Obama as the impotent progressive victim here of recalcitrant, corrupt centrists is really too much to bear.

Yet numerous Obama defenders -- such as Matt Yglesias, Ezra Klein and Steve Benen -- have been insisting that there is just nothing the White House could have done and all of this shows that our political system is tragically "ungovernable." After all, Congress is a separate branch of government, Obama doesn't have a vote, and 60 votes are needed to do anything. How is it his fault if centrist Senators won't support what he wants to do? Apparently, this is the type of conversation we're to believe takes place in the Oval Office:

The President: I really want a public option and Medicare buy-in. What can we do to get it?

Rahm Emanuel: Unfortunately, nothing. We can just sit by and hope, but you're not in Congress any more and you don't have a vote. They're a separate branch of government and we have to respect that.

The President: So we have no role to play in what the Democratic Congress does?

Emanuel: No. Members of Congress make up their own minds and there's just nothing we can do to influence or pressure them.

The President: Gosh, that's too bad. Let's just keep our fingers crossed and see what happens then.

In an ideal world, Congress would be -- and should be -- an autonomous branch of government, exercising judgment independent of the White House's influence, but that's not the world we live in. Does anyone actually believe that Rahm Emanuel (who built his career on industry support for the Party and jamming "centrist" bills through Congress with the support of Blue Dogs) and Barack Obama (who attached himself to Joe Lieberman when arriving in the Senate, repeatedly proved himself receptive to "centrist" compromises, had a campaign funded by corporate interests, and is now the leader of a vast funding and political infrastructure) were the helpless victims of those same forces? Engineering these sorts of "centrist," industry-serving compromises has been the modus operandi of both Obama and, especially, Emanuel.

Indeed, we've seen before what the White House can do -- and does do -- when they actually care about pressuring members of Congress to support something they genuinely want passed. When FDL and other liberal blogs led an effort to defeat Obama's war funding bill back in June, the White House became desperate for votes, and here is what they apparently did (though they deny it):

The White House is playing hardball with Democrats who intend to vote against the supplemental war spending bill, threatening freshmen who oppose it that they won't get help with reelection and will be cut off from the White House, Rep. Lynn Woolsey (D-Calif.) said Friday. "We're not going to help you. You'll never hear from us again," Woolsey said the White House is telling freshmen.

That's what the White House can do when they actually care about pressuring someone to vote the way they want. Why didn't they do any of that to the "centrists" who were supposedly obstructing what they wanted on health care? Why didn't they tell Blanche Lincoln -- in a desperate fight for her political life -- that she would "never hear from them again," and would lose DNC and other Democratic institutional support, if she filibustered the public option? Why haven't they threatened to remove Joe Lieberman's cherished Homeland Security Chairmanship if he's been sabotaging the President's agenda? Why hasn't the President been rhetorically pressuring Senators to support the public option and Medicare buy-in, or taking any of the other steps outlined here by Adam Green? There's no guarantee that it would have worked -- Obama is not omnipotent and he can't always control Congressional outcomes -- but the lack of any such efforts is extremely telling about what the White House really wanted here.

Independent of the reasonable debate over whether this bill is a marginal improvement over the status quo, there are truly horrible elements to it. Two of the most popular provisions (both of which, not coincidentally, were highly adverse to industry interests) -- the public option and Medicare expansion -- are stripped out (a new Washington Post/ABC poll out today shows that the public favors expansion of Medicare to age 55 by a 30-point margin). What remains is a politically distastrous and highly coercive "mandate" gift to the health insurance industry, described perfectly by Digby:

Obama can say that you're getting a lot, but also saying that it "covers everyone," as if there's a big new benefit is a big stretch. Nothing will have changed on that count except changing the law to force people to buy private insurance if they don't get it from their employer. I guess you can call that progressive, but that doesn't make it so. In fact, mandating that all people pay money to a private interest isn't even conservative, free market or otherwise. It's some kind of weird corporatism that's very hard to square with the common good philosophy that Democrats supposedly espouse.

Nobody's "getting covered" here. After all, people are already "free" to buy private insurance and one must assume they have reasons for not doing it already. Whether those reasons are good or bad won't make a difference when they are suddenly forced to write big checks to Aetna or Blue Cross that they previously had decided they couldn't or didn't want to write. Indeed, it actually looks like the worst caricature of liberals: taking people's money against their will, saying it's for their own good --- and doing it without even the cover that FDR wisely insisted upon with social security, by having it withdrawn from paychecks. People don't miss the money as much when they never see it.

In essence, this reinforces all of the worst dynamics of Washington. The insurance industry gets the biggest bonanza imaginable in the form of tens of millions of coerced new customers without any competition or other price controls. Progressive opinion-makers, as always, signaled that they can and should be ignored (don't worry about us -- we're announcing in advance that we'll support whatever you feed us no matter how little it contains of what we want and will never exercise raw political power to get what we want; make sure those other people are happy but ignore us). Most of this was negotiated and effectuated in complete secrecy, in the sleazy sewers populated by lobbyists, industry insiders, and their wholly-owned pawns in the Congress. And highly unpopular, industry-serving legislation is passed off as "centrist," the noblest Beltway value.

Looked at from the narrow lens of health care policy, there is a reasonable debate to be had among reform advocates over whether this bill is a net benefit or a net harm. But the idea that the White House did what it could to ensure the inclusion of progressive provisions -- or that they were powerless to do anything about it -- is absurd on its face. Whatever else is true, the overwhelming evidence points to exactly what Sen. Feingold said yesterday: "This bill appears to be legislation that the president wanted in the first place."

UPDATE: It's also worth noting how completely antithetical claims are advanced to defend and excuse Obama. We've long heard -- from the most blindly loyal cheerleaders and from Emanuel himself -- that progressives should place their trust in the Obama White House to get this done the right way, that he's playing 11-dimensional chess when everyone else is playing checkers, that Obama is the Long Game Master who will always win. Then, when a bad bill is produced, the exact opposite claim is hauled out: it's not his fault because he's totally powerless, has nothing to do with this, and couldn't possibly have altered the outcome. From his defenders, he's instantaneously transformed from 11-dimensional chess Master to impotent, victimized bystander.

The supreme goal is to shield him from all blame. What gets said to accomplish that goal can -- and does -- radically change from day to day.

UPDATE II: I'll be on MSNBC this afternoon at 3:00 p.m. EST with David Schuster/Tamron Hall discussing this post.

UPDATE III: Over at Politico, Jane Hamsher documents how Joe Lieberman's conduct on the health care bill provides the perfect vehicle to advance the agenda of the White House and Harry Reid. Consistent with that, she independently notes media reports that White House officials are privately expressing extreme irritation with Howard Dean for opposing the Senate bill as insufficient, but have nothing bad to say about Lieberman, who supposedly single-handedly sabotaged what the White House was hoping for in this bill.

UPDATE IV: Immediately prior to the MSNBC segment I just did -- video for which I will post when it's available -- an NBC reporter explained how Robert Gibbs used his Press Briefing today to harshly criticize Howard Dean for opposing the health care bill. Why did Gibbs never publicly criticize people like Blanche Lincoln, Ben Nelson, Joe Lieberman and the like if they were supposedly obstructing and impeding the White House's agenda on health care reform (this is a point Yglesias acknowledges as a "fair" one)? Having a Democratic White House publicly criticize a Democratic Senator can be a much more effective pressure tactic than doing so against a former Governor who no longer holds office.

Meanwhile, as one would expect, health insurance stocks are soaring today in response to the industry-serving "health care reform" bill backed by the Democratic Senate and White House -- the same people who began advocating the need for "health care reform" in order to restrain on an out-of-control and profit-inflated health insurance industry (h/t Markos).

UPDATE V: Here's the roughly 4-minute segment I did with David Shuster today

Senate rejects importation of prescription drugs

Sad, but true.. and how much are you paying for medication today? (If you're unfortunate enough to have to buy it, of course.)

The proposal had threatened to derail the Democrats' landmark healthcare bill. Meanwhile, Obama and many liberals back the decision to drop the 'public option.'

By Noam N. Levey and Janet Hook

5:01 PM PST, December 15, 2009

Reporting from Washington

In a victory for President Obama and his allies in the pharmaceutical industry, the Senate today turned aside a bid by a bipartisan group of lawmakers to make it easier to import cheaper prescription drugs from Canada and Western Europe -- a proposal that threatened to derail the Democrats' landmark healthcare bill.

The vote on the amendment -- cosponsored by Sens. Byron Dorgan (D-N.D.) and John McCain (R-Ariz.) -- was 51-48, nine short of the 60 needed to pass.

The politically charged amendment held up the Senate for a week as drug companies, the White House and lawmakers from states that are home to drug makers fought to derail the proposal. Critics, including the Food and Drug Administration, said it would be difficult to implement and hard to guarantee that imported drugs would be safe.

Further adding to the momentum for final Senate approval of the massive healthcare bill, Obama and many liberal Democrats rallied behind the decision to put aside a goal liberals had long held as an article of faith -- a new government health insurance plan to compete with the private sector.

Obama summoned Senate Democrats to the White House today to urge them not to let disagreements over details of the legislation derail or delay the landmark effort.

"This reform has to pass on our watch," the president said. "We are on the precipice of an achievement that has eluded Congresses and presidents for decades."

While some liberals mourned the capitulation that has long seemed inevitable, leaders of several progressive groups signaled that they would support the strategy for now rather than risk stalling their drive.

"The final bill won't include everything that everybody wants," Obama said.

The president weighed in at a critical moment, as Senate Majority Leader Harry Reid (D-Nev.) was working to unite their party in advance of key votes on the compromise that did not include the so-called "public option" -- a new government-run health insurance plan -- or an alternative plan to expand Medicare, which was popular with liberals.

A vast array of details have yet to be pinned down, but the framework of the Senate bill came into view as Reid pushed the Senate to finish work before Christmas. The sense of gathering momentum was fueled as disputes on other issues were resolved: Behind-the-scenes negotiations continued to resolve differences among Democrats over restrictions on federal funding for abortion.

The drug amendment had in the past enjoyed broad support from Democrats -- including Obama -- but the White House and Senate leaders bowed to the pharmaceutical industry and joined their effort to derail it. The administration feared that if the amendment had passed, pharmaceutical companies, which earlier this year struck a deal with the White House to limit the economic impact of a healthcare overhaul on their industry, would turn against the broader health legislation.

To appease critics, Reid pledged this week to work with House leaders to ensure that a final bill would close the so-called Medicare doughnut hole, a gap in prescription drug coverage that forces millions of seniors to pay for thousands of dollars of drugs out of their own pockets.

On the broader questions, Reid plans to unveil the details of his final compromise Wednesday after receiving an official report on its costs and impact. After that, Reid is expected to begin the complex procedural steps required to cut off Republicans' filibuster, with the first of a series of crucial votes coming as early as Friday.

Without any GOP support, all 60 lawmakers in the Democratic caucus, including two independents, will have to vote for the procedural motions in order for the bill to advance. It will then have to be reconciled with a version passed last month by the House, a stronger bulwark of liberalism than the Senate.

House Democrats welcomed the apparent end of the Senate's stalemate on the legislation, but were not happy about the drift of its compromises.

"We in the House have made a beautiful souffle, but the Senate has scrambled an egg," said Rep. George Miller (D-Martinez), noting that Reid already had said he expected to go along with the House in closing the Medicare doughnut hole. "Let's hope they will find more they like in the House bill."

Some liberals pledged to vote against the bill if it is in the Senate mold, but Democratic leaders steered clear of such ultimatums. House Majority Leader Steny Hoyer (D-Md.) told reporters that the House could pass the health bill without a public option, contrary to earlier warnings. That was in keeping with advice Democrats say they received long ago from Obama lieutenants like Chief of Staff Rahm Emanuel, who argued that passing any bill would be better than failing to act.

"Rahm told us months ago: Everything can be compromised except our ultimate goal of getting something done," said Rep. Jim Moran (D-Va.). "Everything else is negotiable."

And liberals acknowledged they were in a weak bargaining position because conservatives were willing to kill the bill over their disagreements -- and Democrats were not.

"We progressives are negotiating with a gun to our heads," said Rep. Anthony Weiner (D-N.Y.). "Our opponents are saying, 'Go ahead and shoot.' If you're a public option fan, you haven't had a good week."

The final push for Senate action picked up important support today from several leading consumer groups, including AARP, the American Cancer Society Cancer Action Network, Consumers Union and Families USA. The groups plan to join the Service Employees International Union, which has been a leading advocate for a new government insurance plan, at the Capitol on Wednesday to urge senators to quash a Republican-led filibuster next week.

And Health Care for America Now, the influential coalition of liberal activist groups, today decided to send a letter to Reid calling for passage of the legislation, the group's campaign manager Richard Kirsch said.

"There are major problems with the Senate bill," Kirsch said in an interview today. "But if the Senate doesn't act, there will be no healthcare reform. . . . The place to fix [the Senate bill] is in a conference committee" with House and Senate leaders at the table.

The White House meeting came one day after Senate Democrats moved to back down from the idea of expanding Medicare in lieu of the public option, bowing to opposition from conservative Democrats and independent Sen. Joe Lieberman of Connecticut. Democrats were infuriated at Lieberman because he had supported the expansion of Medicare in the past, but the White House tried to defuse that anger.

"If we held flip-flops against everybody in the Congress, we'd probably not have many people there," Vice President Joe Biden said in an interview on MSNBC's "Morning Joe" program.

Lieberman joined Obama and Democrats at the White House and signaled that he planned to vote for the bill, according to sources briefed on the meeting. Obama urged others to see the glass as half full, emphasizing that the legislation, like the landmark 1965 law that created Medicare, is a foundation for further improvements in the future.

"Be joyful; be grateful," Obama said, according to Senate Finance Committee Max Baucus (D-Mont.). "We'll build upon it in the future."

In his public comments after the meeting, he said that the emerging Senate bill meets the major criteria he set out in a healthcare speech before a joint session of Congress: It would expand coverage, does not add to the deficit, and slows the rate of growth of healthcare costs.

Beyond that, Obama said, "We simply cannot allow differences over individual elements of this plan to prevent us from meeting our responsibility to solve a long-standing and urgent problem for the American people," Obama said. "They are waiting for us to act. They are counting on us to show leadership. And I don't intend to let them down."

Neither does as staunch a liberal as Sen. Sherrod Brown (D-Ohio), who has steadfastly refused to compromise on including a public option. He said after meeting with Obama that he would vote for the bill despite his reservations.

"There is too much at stake," he said. "And it's about me. It's not about any senator. It's not about Lieberman."

noam.levey@latimes.com

janet.hook@latimes.com

Senate healthcare bill: Time to kill it?

Is reform without public option worth it? Markos, Ezra Klein, Paul Krugman, Howard Dean and others weigh in

Some progressives say that without a public option, it is. Others on the left say any progress is better than none

Thomas Schaller

Dec. 15, 2009

Is the watered-down, no-public-option healthcare reform bill worth saving? Or should it be killed? That is the question on everyone's lips today.

By Twitter, Markos of Daily Kos let it be known where he and many progressives stand on the issue: "Insurance companies win. Time to kill this monstrosity coming out of the Senate."

That specific tweet, and the broad sentiment that underlies it, is generating quite a bit of response. The WaPo's Ezra Klein writes on his blog:

The core of this legislation is as it always was: $900 billion, give or take, so people who can't afford health-care insurance suddenly can. Insurance regulations paired with the individual mandate, so insurers can't discriminate against the sick and the healthy can't make insurance unaffordable by hanging back until the moment they need medical care. The construction of health insurance exchanges so the people currently left out of the employer-based market are better served, and the many who will join them as the employer system continues to erode will have somewhere to go.

That's all policy. And as I spent yesterday arguing, it has a tendency to overshadow the lives in the balance. You can choose your estimate. The Institute of Medicine's methodology says 22,000 people died in 2006 because they didn't have health-care coverage. A recent Harvard study found the number nearer to 45,000. Since we talk about the costs of health-care reform over a 10-year period, may as well talk about the lives saved that way, too. And we're looking, easily, at more than a hundred thousand lives, to say nothing of the people who will be spared bankruptcy, chronic pain, unnecessary impairment, unnecessary caretaking, bereavement, loss of wages, painful surgeries, and so on.

A lot of progressives woke up this morning feeling like they lost. They didn't. The public option and its compromised iterations were a battle that came to seem like a war. But they weren't the war. The bill itself was. When liberals talked about the dream of universal health-care insurance 10, 20 and 30 years ago, they talked about the plight of the uninsured, not the necessity of a limited public option in competition with private insurers.

Salon reached out to others with strong opinions on this issue, and we will be updating this post as reactions come in, so stay tuned.

In contrast to Klein, Stephanie Taylor, co-founder of Progressive Change Campaign Committee, told us:

The "Joe Lieberman Senate Bill" is ugly. Democrats stand on the verge of ushering in a world of nearly unregulated mandates, in which we're all forced by the state to hand over our money to failed private monopolies, with no cost control in return. Without a public option and no hope of expanding Medicare coverage, this bill is not worth supporting.

We got to this point due to a complete failure of leadership by President Obama--who chose to negotiate with out-of-touch senators instead of rallying their own constituents against them. It's also a failure of leadership by Harry Reid, who failed to exert any leverage over Joe Lieberman--by threatening to take away his committee chairmanship or use reconciliation to make his vote irrelevant.

When Democratic leaders refuse to fight, they can't then ask progressives to cave with them. The Progressive Change Campaign Committee is continuing to fight for the best health care bill possible, and we're intent on holding Democrats' feet to the fire. But we need to think very seriously about whether there will be a moment when it is clear that the bill does more harm than good--we need to be prepared to kill the bill.

Part of being a great negotiator is being able to walk away.

Jonathan Cohn, author of Sick and writer for the New Republic, more closely echoed Klein's view:

Is health care reform without a public option still worth passing? Unequivocally, unambiguously yes.

The case for is simple and straightforward: 30 million additional people, maybe more, will have health insurance. Many more who have insurance will see their coverage become more stable. The ability of insurers to exclude people based on pre-existing conditions will diminish significantly, if not disappear. And that's on top of a host of delivery reforms which should, in combination, help make medical care less expensive over time. The bill could be much better, for sure, but to argue that it's worse than nothing you have to make the case that nothing will somehow lead to more progress in some reasonable frame of time.

I don't see that. Failure to pass health reform won't lead to a progressive revival or resurgence. It will cripple the Democrats, hand the Republicans more political power, and likely to send health care reform into hibernation for another ten to twenty years. It's theoretically possible we could get a better reform at that point. But the historical trend is in the opposite direction. Every new effort is a less ambition version of the old one. Meantime, millions of more people would suffer.

Pass this bill now. Improve it later. That's the way we do things in America, for better or for worse.

Goldman Sachs redefines "fat cat"

Numbers reflect what the executives already own right now irrespective of whether they get their 2009 bonuses paid in cash this year, or doled out to them as "restricted" stock that they won't be able to sell for as long as five years.Lloyd Blankfein, CEO and Chairman of the Board, owns 1,685,932 shares of Goldman, worth $274,393,733

Lloyd Blankfein can afford to wait for his bonus. His net worth in company stock is a cool $275 million, today

Andrew Leonard, Salon.com

Dec. 15, 2009

At The Big Picture, Tim Iacano provides an eye-popping chart detailing the stock holdings of Goldman Sach's top executives. The important thing to note is that the numbers reflect what the executives already own right now irrespective of whether they get their 2009 bonuses paid in cash this year, or doled out to them as "restricted" stock that they won't be able to sell for as long as five years.

Lloyd Blankfein, CEO and Chairman of the Board, owns 1,685,932 shares of Goldman, worth $274,393,733.

Gregory Palm, Executive VP, owns 939,742 shares, worth $152,943,011.

John Weinberg, Vice Chairman, owns 910,324 shares, worth $148,155,231.

David Viniar, Chief Financial Officers, owns 794,902, worth $129,370,301.

J. Michael Evans, Vice Chairman, owns 644,953, worth $104,966,101.

And so on.

Now we know why Blankfein was so miffed at Obama's "fat cats" comment that he couldn't manage to physically attend the Monday morning pow-wow in Washington. He's not a fat cat. He's a Godzilla-sized Sabertooth Tiger Monster. Get it straight, Mr. President.

Pittsburgh Sets Vote on Adding Tax on Tuition

By IAN URBINA. NY Times

The mayor of Pittsburgh calls it the “Fair Share Tax.” But to officials at the city’s 10 colleges and universities and many of their 100,000 students, it is anything but.

On Wednesday, the City Council is expected to give preliminary approval to Mayor Luke Ravenstahl’s proposal for a 1 percent tuition tax on students attending college in Pittsburgh, which he says will raise $16.2 million in annual revenue that is needed to pay pensions for retired city employees. Final Council action will be on Monday.

The tax would be the first of its kind in the nation, and other cities are watching closely as they try to find ways to close their own budget gaps.

Students and college officials argue that the tax will drive students away and place an unfair burden on institutions that already contribute substantially to the city. They add that the measure comes at an especially difficult time for colleges, as endowment values have fallen and requests for financial aid have risen.

The tax, which will most likely end up in the courts, represents a turning point for Pittsburgh, which has remade itself after the steel mills shut down, becoming a hub for nonprofit hospitals and universities. Yet it has been unable to draw significant revenue from its new identity.

“It’s really a disappointment that we’re in this situation,” Mayor Ravenstahl said. “Our colleges and universities are giving less and less while they increase tuition and executive pay and expand their campuses, removing high-value land from the tax rolls. The cost to provide public safety and public works services continues to increase, but our revenue continues to decrease.”

The tax, which would take effect as early as July, would range from about $20 a year for students at cheaper schools like the Community College of Allegheny County to just over $400 for students at the city’s priciest university, Carnegie Mellon.

As a town-gown clash, the issue pits local taxpayers against mostly out-of-state students. But it is also a struggle between the old Pittsburgh and the new, as the mayor tries to force the city’s youngest residents to support some of its oldest.

Other cities have considered going this route. This spring, for example, Mayor David N. Cicilline of Providence, R.I., proposed a $150-per-semester tax on students at the city’s four private colleges. The State Legislature, however, did not take it up.

And in Boston, Mayor Thomas M. Menino created a task force in January to explore increasing voluntary payments from the city’s universities and hospitals.

“City officials see this as an untapped revenue source, and if Pittsburgh succeeds, I think you will see a lot of other cities immediately move to do the same,” said Terry Hartle of the American Council on Education, a lobbying group for universities. He added that if the Pittsburgh City Council approves the mayor’s proposal, the matter will surely go to the courts.

Students and university officials are not pleased.

The added cost “could prevent prospective students from coming to Carnegie Mellon, and Pittsburgh would be missing out on some of the best talent from around the world,” said an editorial published this month in The Tartan, the student newspaper at Carnegie Mellon.

Officials at the University of Pittsburgh said they would “vigorously oppose any attempt to impose a service or privilege fee on our undergraduate and graduate students.”

But Mr. Ravenstahl said he was left with no other option.

He said that he asked the universities and other tax-exempt nonprofits to pay $5 million annually to the city, and that in lieu of the tax he would find the other $10 million by dipping into reserves, cutting services and getting Harrisburg to increase the commuter tax rate.

Mr. Ravenstahl said the city currently forgoes about $50 million in real estate taxes from nonprofit institutions.

The universities rejected his request last week.

In a four-page letter, the Pittsburgh Council on Higher Education said it refused to consider payments as long as the mayor continued the threat of a tax that it called divisive, illegal and unenforceable.

The council added that the city’s colleges and universities pay $23 million annually in taxes to the city for payroll, parking, business privileges and any real estate not directly related to their educational missions.

Politically, Mr. Ravenstahl risks few votes in leaning on universities for revenue because college students rarely vote in local elections. And many of the constituencies that supported Mr. Ravenstahl’s re-election in November have been vocally supportive of his tax plan.

“This is a turning point for us,” said Joe King, president of the Pittsburgh firefighters’ union. He said that after Miami-Dade County in Florida, Allegheny County has the second largest number of seniors of any county in the United States and that in his union alone he has 900 retirees and 450 surviving spouses whose pensions need to be financed.

“Without the tax, the fate of those pensions could be in trouble,” he said. “We are not asking young people to carry more than their due. We’re just asking them to pay for what they use.”

But students say they already do.

“We have jobs in Pittsburgh so we pay taxes on that income, we rent apartments so we pay taxes on that, we have cars here, which provide parking taxes,” said David Gau, an undergraduate at the University of Pittsburgh, adding that he resented the portrayal of students as freeloaders. “We go to a variety of events like symphony, sports games, plays, concerts, and there are amusement taxes on those that produce even more revenue from us.”

“Why try to divert new people from coming here with a college tax?” added Mr. Gau, 21, who is from Kennett Square, Pa. “It’s the furthest thing from fair.”

Chad Ellis, 28, a graduate student in chemistry at Carnegie Mellon University and a Pittsburgh homeowner, agreed.

“Holding students hostage in negotiations with nonprofits to come up with money to pay for bloated city pension plans is divisive,” he said.

Growing Miracles: McGowan Institute for Regenerative Medicine Featured on CBS Evening News

CBS Evening News highlighted the work of several McGowan Institute researchers and characterized these pioneering studies as the “Holy Grail of Healing” of regenerative medicine. The innovative work of McGowan Institute researchers—Drs. Stephen Badylak, Jorge Gerlach, William Wagner, and Joon Sup Lee—was featured in the coverage.

Beginning with the re-grown, now 2-year-old fingertip of Lee Spievak, Stephen Badylak, DVM, PhD, MD, Deputy Director of the McGowan Institute, discussed extracellular matrix (ECM)—a medical product derived from pig bladders that has been demonstrated to regenerate tissue. Dr. Badylak believes ECM mobilizes cells, some of them adult stem cells whose job it is to maintain and repair injured tissue.

Steven Wolf, PhD, U.S. Army Institute for Surgical Research, San Antonio, hopes that this technology can be used by the Army to one day re-grow limbs, lost muscle, even burned skin of injured soldiers. Dr. Wolf asks, “Is there any way we can make that grow back? Some of that technology exists and now it’s time to field it.” Currently, the Army is working with Dr. Badylak and his ECM technology on the amputated fingers of soldiers home from the war. The Army also hopes the work of Jorge Gerlach, MD, PhD, Professor in the Department of Surgery, University of Pittsburgh, on the development of an alternative approach to mend skin damaged by burns and abrasion-type injuries through the use of a spray gun and bioreactor will be available soon to soldiers.

Presented also during the segment was the advanced tissue engineering and stem cell therapy work relative to the heart. Noted was the work of William Wagner, PhD, Deputy Director of the McGowan Institute for Regenerative Medicine—an artificial scaffold patch that some day may be used to repair scar tissue on the cardiac muscle following a heart attack. Once the scar tissue on the cardiac muscle is removed and replaced with the artificial scaffold patch, it will grow new cardiac tissue and restore functional cardiac muscle. Stem cell therapy injections into the heart was explained by Joon Sup Lee, MD, Clinical Director of the Cardiovascular Institute at the University of Pittsburgh Medical Center, in conjunction with a patient who recently received injections of her own stem cells in hopes of growing new heart arteries.

These are only a few of the programs led by Institute researchers who are working to create new therapies utilizing tissue engineering and cellular therapies. The CBS program shared the long term vision that some day we may be able to have re-grown limbs to replace prosthetics, when re-grown tissues replace surgery, and when the body does its healing with its own cells from within.

Dr. Badylak is also Professor in the Department of Surgery, University of Pittsburgh. Dr. Wagner is also Professor of Surgery, Bioengineering and Chemical Engineering at the University of Pittsburgh. Dr. Lee is also Assistant Professor of Medicine at the University of Pittsburgh and Associate Chief in the Division of Cardiology at the University of Pittsburgh School of Medicine.

Twitter Tapping

NY Times Editorial, Dec. 12, 2009

The government is increasingly monitoring Facebook, Twitter and other social networking sites for tax delinquents, copyright infringers and political protesters. A public interest group has filed a lawsuit to learn more about this monitoring, in the hope of starting a national discussion and modifying privacy laws as necessary for the online era.

Law enforcement is not saying a lot about its social surveillance, but examples keep coming to light. The Wall Street Journal reported this summer that state revenue agents have been searching for tax scofflaws by mining information on MySpace and Facebook. In October, the F.B.I. searched the New York home of a man suspected of helping coordinate protests at the Group of 20 meeting in Pittsburgh by sending out messages over Twitter.

In some cases, the government appears to be engaged in deception. The Boston Globe recently quoted a Massachusetts district attorney as saying that some police officers were going undercover on Facebook as part of their investigations.

Wired magazine reported last month that In-Q-Tel, an investment arm of the Central Intelligence Agency, has put money into Visible Technologies, a software company that crawls across blogs, online forums, and open networks like Twitter and YouTube to monitor what is being said.

This month the Electronic Frontier Foundation and the Samuelson Law, Technology and Public Policy Clinic at the University of California, Berkeley, School of Law sued the Department of Defense, the C.I.A. and other federal agencies under the Freedom of Information Act to learn more about their use of social networking sites.

The suit seeks to uncover what guidelines these agencies have about this activity, including information about whether agents are permitted to use fake identities or to engage in subterfuge, such as tricking people into accepting Facebook friend requests.

Privacy law was largely created in the pre-Internet age, and new rules are needed to keep up with the ways people communicate today. Much of what occurs online, like blog posting, is intended to be an open declaration to the world, and law enforcement is within its rights to read and act on what is written. Other kinds of communication, particularly in a closed network, may come with an expectation of privacy. If government agents are joining social networks under false pretenses to spy without a court order, for example, that might be crossing a line.

A national conversation about social networking and other forms of online privacy is long overdue. The first step toward having it is for the public to know more about what is currently being done. Making the federal government answer these reasonable Freedom of Information Act requests would be a good start.

Sen. Franken Becomes A Cosponsor Of Vitter/Coburn Amendment

Sen. Franken Becomes A Cosponsor Of Vitter/Coburn Amendment

Sen. Sherrod Brown (Ohio) said he is trying to co-sponsor the amendment -- but that Coburn and Vitter won't let him. Coburn and Vitter are planning to offer the amendment during the Senate floor debate on healthcare reform."They've not said yes to allow me to be a co-sponsor," Brown told The Hill on Thursday.

First reported by The Hill, GOP Sens. Vitter and Coburn had ignored requests by Sen. Sherrod Brown to become a cosponsor of an amendment forcing members of Congress onto the public option.

The Hill continued:

Sen. Sherrod Brown (Ohio) said he is trying to co-sponsor the amendment -- but that Coburn and Vitter won't let him. Coburn and Vitter are planning to offer the amendment during the Senate floor debate on healthcare reform.

"They've not said yes to allow me to be a co-sponsor," Brown told The Hill on Thursday. "I've called their office four times. I'm proud of the public option, I think it would be great and we ought to join it and show the country how good it is. I think my interest may be more genuine than theirs, but I'd like to work with them if they'll let me. If they just want to score partisan points, I still want to work with them."

Undeterred, Sen. Franken beat them at their own game.

–Media Matters Action Network

The Lost Weekend

By GAIL COLLINS

The Senate is going to be in session all weekend, debating the big health care bill and arguing about which direction the cost-curve is heading. This is a positive development on two counts. It keeps senators off the streets while providing much-needed employment in the chart-making sector of our economy.

Or we could just lock them in a basement until they’re done squabbling. Either way is good, but the basement option would have the advantage of covering some of the less-active debaters with an attractive coat of mildew. In any case, I guarantee you that the number of normal Americans who will pay attention can be numbered in the low single digits.

So as a public service to the nonlistening audience, let me give you a summary of the important action so far:

ROUND ONE Republicans: Let’s get rid of all the Medicare savings in the bill. Think of the seniors!

Democrats: Yettaruttayetta.

ROUND TWO Mammograms! Everybody loves them. Can’t have enough.

ROUND THREE Republicans: Let’s get rid of part of the Medicare savings in the bill. Think of the seniors!

Democrats: Ruttayettarutta.

Is that perfectly clear? Good. Now we will return to our regularly scheduled conversation. Did you see that hot reality show “Hoarders” on A&E the other night? What about that lady who hoarded her dead cats? If “Hoarders” gets superpopular, do you think lots of people will start putting dead cats in their living room just so they can get on TV and be famous? Maybe somebody will try to bring dead cats to a state dinner at the White House! Does the Secret Service have a plan to avert this?

Sorry. I’ll behave. Back to the health care bill.

The Republicans are the fiscal conservatives in Congress, at least in the years when they aren’t actually in power. They were never going to rally around an expensive new government program that fails to provide a single new market for corn-based products.

But you would expect them to try to push the whole project in the most economical direction possible.

For instance, the bill would establish an independent commission on Medicare payment rates. This is a very big deal and you are going to have to take my word that health care economists fall over with excitement when it comes up.

But the Senate Democrats’ current version of the bill would only allow the panel experts to act when Medicare spending rises at a faster rate than other health care spending. Since health care spending has been going through the roof, we’re talking about waiting until Medicare spending goes through the ozone layer.

Obviously, this is an area where the Republicans would want to swing into action. And they did. They prepared an amendment eliminating the Medicare panel entirely.

In fact, G.O.P. senators appear to have amendments aimed at wiping out virtually all the cost-cutting the Democrats have put in the bill, including productivity adjustments and incentives for innovation in health care delivery.

If they can’t kill the bill completely, Republicans who are not from Maine seem intent on raising its price tag. While terrifying senior citizens in a cynical attempt to influence their vote in the next election cycle. Although I’m sure Senator Tom Coburn of Oklahoma just misspoke when he said: “I have a message for you: You’re going to die sooner."

On Friday, much of the debate was directed at Medicare Advantage. This is a program that flourished during the privatization craze. And like many attempts to save money by shoehorning private businesses into government programs, it wound up costing a ton. The Medicare Advantage policyholders cost the government 14 percent more than regular Medicare recipients, although they do often get extra benefits, sometimes including free Band-Aids or gym memberships.

Now let us be fair. There are some good services in the Advantage mix, and gym memberships are in and of themselves a fine thing. But you would think the political party that eviscerated the Clinton stimulus plan over an appropriation for late-night basketball programs would really be ticked at the idea that we’re providing a 14 percent subsidy to some Medicare recipients so they can have access to Stairmasters.

Au contraire. In fact, on Thursday Senator Orrin Hatch proposed an amendment that would eliminate the entire $120 billion in Medicare Advantage savings from the bill.

There is no sane explanation for all this other than crass political calculation. On Thursday, Senator Michael Bennet, a Colorado Democrat who’s up for election next year, introduced an amendment specifically promising that Medicare recipients would not lose any of their current guaranteed benefits. It passed 100 to 0. Meanwhile, Colorado voters were getting robocalls from John McCain warning that the health care bill was going to cut their “vital Medicare coverage.”

Now, about those dead cats.

Op-Ed Columnist

By BOB HERBERT

Cambridge, Mass.

For me, the greatest national security crisis in the United States is the crisis in education. We are turning out new generations of Americans who are whizzes at video games and may be capable of tweeting 24 hours a day but are nowhere near ready to cope with the great challenges of the 21st century.

An American kid drops out of high school at an average rate of one every 26 seconds. In some large urban districts, only half of the students ever graduate. Of the kids who manage to get through high school, only about a third are ready to move on to a four-year college.

It’s no secret that American youngsters are doing poorly in school at a time when intellectual achievement in an increasingly globalized world is more important than ever. International tests have shown American kids to be falling well behind their peers in many other industrialized countries, and that will only get worse if radical education reforms on a large scale are not put in place soon.

Consider the demographics. The ethnic groups with the worst outcomes in school are African-Americans and Hispanics. The achievement gaps between these groups and their white and Asian-American peers are already large in kindergarten and only grow as the school years pass. These are the youngsters least ready right now to travel the 21st-century road to a successful life.

But between now and the middle of the century (which is closer than you might think) such youngsters will likely hold an ever more important place in the American work force. By 2050, the percentage of whites in the work force is projected to fall from today’s 67 percent to 51.4 percent. The presence of blacks and Hispanics in the work force by midcentury is expected to be huge, with the growth especially sharp among Hispanics. If America is to maintain its leadership position in the world and provide a first-rate quality of life for its citizens here at home, the educational achievement of American youngsters across the board needs to be ratcheted way up.

It’s in that atmosphere that the Harvard Graduate School of Education is creating a new doctoral degree to be focused on leadership in education. It’s the first new degree offered by the school in 74 years. The three-year course will be tuition-free and conducted in collaboration with faculty members from the Harvard Business School and the Harvard Kennedy School of Government. The idea is to develop dynamic new leaders who will offer the creativity, intellectual rigor and professionalism that is needed to help transform public education in the U.S.

This transformation is a job the U.S. absolutely has to get done, and it won’t get done right without the proper leadership. Kathleen McCartney, the graduate school’s dean, explained one of the dilemmas that has hampered reform. “If you look at people who are running districts,” she said, “some come from traditional schools of education, and they understand the core business of education but perhaps are a little weak on the management side. And then you’ve got the M.B.A.-types who understand operations, let’s say, but not so much teaching and learning.”

The degree to be offered (initially to just 25 candidates) is a doctorate in education leadership (Ed.L.D.). The fact that the program is tuition-free, thanks in large part to an extraordinary grant by the Wallace Foundation, is important. Harvard is trying to reach out to the broadest possible field of potential candidates. “We can’t do that unless we remove all the barriers to studying here,” said Dean McCartney.

The chance that one of the next great leaders in education will be missed because he or she could not afford the high cost of a Harvard doctorate is not one the school wants to take.

When I mentioned how American students are being outpaced academically by their peers in many other countries, Ms. McCartney said, “I think it’s scary. We don’t have national standards, which is something Arne Duncan is working on.” Mr. Duncan is the U.S. secretary of education. Ms. McCartney added, “We’re competing with countries that have a ministry of education where they’re trying to bring good ideas to scale. This is a real challenge for us.”

Students will spend the third year of the doctoral leadership program in a “field placement” at some organization or agency — say, a large urban school district or educational advocacy group — to gain practical experience. School officials likened this aspect of the program to a medical residency. Instead of doing a dissertation, the students will lead an education reform project in that third year.

The overall goal, said Ms. McCartney, is to produce a cadre of highly skilled educational leaders who are committed to reform of the profession, knowledgeable about the way children learn and well-grounded in the real world of practical management and politics.