Tag Archives: health care

Talking back in real time

I’m a huge admirer of Paul Levy, president and CEO of Beth Israel Deaconess, but I can’t pretend I’m in a position to judge the merits of his objections to Gov. Deval Patrick’s proposal to cap medical costs. (Although I do think Levy makes some good points.)

My main reason for posting this is to call attention to the ongoing media revolution made possible by the Internet. Old story though it may be, I think this is an unusually relevant example, and we shouldn’t take for granted the power to talk back:

  • The Boston Globe reports on Patrick’s proposal. For whatever reason, none of the reporters chose to quote Levy.
  • Levy writes what is essentially an op-ed piece in almost-real time, without having to wait for days and be subject to the Globe’s editing process.
  • Levy also links to another account that he believes got it right: an editorial in the Boston Herald.

As for influence, Levy’s blog, Running a Hospital, gets about 10,000 unique visitors a month, according to Compete.com. Obviously the Globe’s circulation is much larger. But how often do you read guest op-eds? Yeah, me too. Levy may well attract as many if not more readers by posting on his blog than if his piece had run in the Globe.

One thing I’ll point out, and, frankly, Levy should have: he is supporting Patrick’s main rival in the gubernatorial contest, Republican Charlie Baker, former head of Harvard Pilgrim Health Care. Levy no doubt thinks that fact is well-known, especially among the specialized audience that reads his blog. But disclosure never hurts, and it often helps.

Democracy and the Senate

Both the Boston Globe and the New York Times today run stories on the fate of health-care reform in the event that Republican candidate Scott Brown defeats Democrat Martha Coakley in tomorrow’s special election for the U.S. Senate.

In light of that, I want to address the notion that it would be somehow undemocratic if the House could be persuaded to pass the Senate bill, thus avoiding a return trip to the Senate, or if a compromise measure were rushed through before Brown can be sworn in.

First, let’s look at the composition of the Senate itself. Even if Brown wins, the Senate will comprise 59 Democrats or their allies and 41 Republicans. Only in the upside-down world of the modern Senate would that be considered anything less than an enormous advantage.

What gives the Republicans clout, of course, is their unprecedented strategy of filibustering vote after vote. As Paul Krugman recently noted, a study by the political scientist Barbara Sinclair found that the routine filibuster is a very recent phenomenon, and entirely Republican in origin.

If the Republicans are going to insist that 60 votes are needed to get anything done, then rules reform ought to be the first order of the day. My preference would be an insistence that filibusters be carried out the old-fashioned way, Jimmy Stewart-style, on the floor of the Senate. Harry Reid could play Lyndon Johnson, forcing everyone to stay in the chamber until human biology brought an end to the charade.

My second point is that we tend to forget what a distorting effect the Constitution’s two-senators-per-state rule has with regard to whose voice gets heard. I ran some numbers a little while ago; in states with one Democrat and one Republican, I awarded half the population to each. Using that formula, I found that Democratic senators represent 196 million Americans, and Republican senators represent just 110 million.

Thus the Senate’s 60-40 margin in favor of Democrats would widen to 64-36 if the one-person/one-vote rule were followed. And a Brown victory would barely affect that margin, as it would be 63 percent to 37 percent.

There’s no question that a Brown victory would have an enormous psychological effect. It’s hard to know whether congressional Democrats would push something through in order to put health care behind them once and for all, or if they would decide instead to give up on the whole effort.

But that’s a matter for another day — perhaps Wednesday.

The Krauthammer compromise

Conservative columnist Charles Krauthammer, a physician, suggests what sounds to me (admittedly no expert on this phenomenally complex subject) like a reasonable compromise that would deliver to President Obama the universal health-care bill he wants while overcoming most of the objections.

Here’s the problem. Krauthammer does not acknowledge the very real possibility that Republican leaders have settled on defeating health-care reform as a strategy for politically wounding Obama — the details be damned. I suspect that Obama could embrace the Krauthammer ideas in total, only to see the GOP move the goal posts on him. (Via Jay Fitzgerald.)