Health care is an area of policy that is of almost outsized importance to me, even though I don't write about it all that much these days.  So, naturally, I found this interesting-- it summarizes a McKinsey article about how to fix the US health care system (or perhaps more accurately, what to focus on in attempting to fix it).  I was pleased to see that much of what is detailed here corresponds to things I've been saying for quite awhile, and even a lot of what I was saying last year in my capacity as RNC spokeswoman, advocating for John McCain:

Back in December, 2008, the folks at McKinsey - one of the world’s most well known consulting firms -  wrote an interesting article on health care reform in the U.S.  What’s striking about it now as we all watch the debate unfold in Washington, DC is how different McKinsey’s approach is to the one being taken in our nation’s capital.  McKinsey focused on three things - personal behavior, cost and quality transparency, and administrative simplification. 

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People in DC would argue that doing anything about personal behavior is virtually impossible, so why bother, but McKinsey’s case on this one is pretty compelling.  In fact, McKinsey argues that the whole “40% of individual health care expenses occur in the last year of life” is no longer true - primarily due to the rise in costs associated with managing chronic conditions.  Quote - “…our findings suggest that the management of chronic disease outside of acute-care environments accounts for at least 20 percent of total U.S. health care spending, perhaps more.  That level of expenditure, compounded over decades in many cases, dwarfs the cost of end-of-life care…”  They indicate that end-of-life health care spending - on average - for people who pass away between the ages of 65 and 95 represents less than 10% of the total amount of money they spend on health care during their lifetimes.

McKinsey references obesity as a specific example.  The incidence of clinically defined obesity has doubled in the U.S. since 1980 - to roughly 34% of the adult population.  Clinically obese patients spend almost twice as much as someone with a normal body mass index on health care - every single year.  Put another way, if we were as obese today as we were in 1980, we’d spend $60 billion less on health care.  McKinsey says ignoring the impact personal behavior - and here, I’m mostly referencing diet and exercise - has on the rising cost of health care is a huge missed opportunity, and their data points make a compelling case.

Second, McKinsey points out that the same service provided by two different providers in the same geographic area with the same patient and the same outcome can vary in cost by as much as 40%, and no one knows it.  “In no other industry are service attributes and prices so opaque.”  No kidding.  Some of us having been banging this drum for years, and we are still in the crawl stage in terms of making this sort of information publicly available.  And while I’ve always thought of that as a way to rationalize provider prices, McKinsey thinks it could also rationalize insurance plan design and re-frame the health care conversation generally.  They note that without publicly available information on price and performance, the move from delivery and insurance models that are based on acute episodes of injury or illness to ones that are based on promoting healthy behaviors and managing chronic conditions will take forever to occur.

You can read the rest of the item for the administrative portion, which isn't nearly as interesting to me as these first two points, both of which were (incidentally) specific focal points of the McCain health care plan and which I personally feel were not, and are not, being given nearly as much attention as they deserve from the Obama administration (then the Obama campaign).  Note the below excerpts of this Carly Fiorina item on health care policy written last year for evidence that someone was thinking about these aspects of the health care dilemma last year, even if it's not the guy who ultimately got elected:

But those are not the only components of what John McCain is proposing with regard to health care. In addition, he plans to expand the benefits of Health Savings Accounts (HSAs), and bring down actual health care costs (as opposed to insurance costs). In part, this would be accomplished by bringing greater competition to our pharmaceutical markets via safe reimportation of drugs and faster introduction of generic drugs into the market. It also would be accomplished by focusing federal research efforts on curing chronic disease, promoting new treatment models, rewarding quality and encouraging preventive health care. Incredibly, treating chronic disease accounts for three-quarters of America’s annual health care bill. So, getting chronic disease under control will help bring costs under control, while improving Americans’ health, overall.

Increasing transparency with regard to health care costs also is critical. Too frequently, patients find themselves in the dark when it comes to medical costs and outcomes, which does nothing to promote keeping costs down and quality high. John McCain wants prices and doctors’ and hospitals’ ratings up on the Internet for everyone to see — and he firmly believes that will serve to promote quality treatment while helping to drive costs down.

My point here is not to whine, though, or play sore loser.  More where I'm going is to ask whether Obama, who wants to be seen as implementing the best policy ideas irrespective of where they emanate from in virtually every area of policy, is prepared to actually do that on health care.  McKinsey may not be the be-all-and-end-all, but they are a very credible organization, and are treated as such by people on both sides of the aisle inside and outside DC.  These aspects of the McCain health care plan were also, from what I understood at the time, treated pretty credibly by a lot of those focused on the issue of health care (if not the Obama campaign itself, from everything I saw) irrespective of philosophy or ideology. 

If Obama is serious about reforming and improving American health care, rather than just pursuing what looks like health care reform in the genus of what is pretty comfortable and predictable for Democrats and their supporters, he might give real consideration to these points.  Focusing deeply on what to do about chronic disease and on introducing transparency in costs and outcomes is not a "liberal" or "conservative" thing to do-- it's a pragmatic and smart thing to do, though one that would involve paying attention to potential solutions beyond those typically touted as part of liberal health care orthodoxy.

(Full disclosure: One of my brothers works for McKinsey). ...
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Check out this, from Politico's front page:

Note the caption: "Democratic leaders warn supporters that they won't be able to accomplish everything they set out to do this year."

As Politico correctly notes, if Franken is seated as a Senator, Harry and his friends will have a bulletproof, 60 vote majority.

That means the GOP won't be able to filibuster.

But even with that major obstacle to Democrats passing bills eliminated, it seems Harry & Co still won't be able to get it together to pass items that evidently constitute noteworthy parts of their agenda.

I don't spend a lot of time touting Republican leadership in the Senate, but I will say this: I'm pretty sure that with 60 votes, our guys could get stuff that matters as much to our base as things like closing  the "gun-show loophole" do to the Democratic party base passed into law.

Separately, you've got to wonder just how unpopular core Democratic agenda items like individual gun control efforts or, say, card check (i.e., the Employee "Free" Choice Act) are among the population at large if Senate Democrats, with their 60 votes, can't seem to get enough of their own members onside to progress them.  60 votes or no, this smacks of the Democratic party continuing to be the philosophical home of some pretty unapalatable policy prescriptions.

Democratic leadership FAIL. ...
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That is essentially the message sent by Chris Van Hollen, Chair of the DCCC and assistant to Nancy Pelosi, and House Majority Whip Jim Clyburn, to Democratic House members earlier this week:

As the House prepared to vote this week on Republican Rep. Jeff Flake’s push for an ethics investigation involving Rep. John Murtha and other senior appropriators, Democratic leaders sent an unmistakable message to their members:

“Don’t be a Flake.”

That was the subject line of an e-mail that staffers for first- and second-term Democrats received Tuesday from Rep. Chris Van Hollen, assistant to Speaker Nancy Pelosi. The message said that Democrats would once again be “voting to table another Flake resolution” — and it made clear that leadership would have its eyes on any Democrats even thinking about defecting.

Not that they needed reminding.

In another pre-vote e-mail, the office of House Majority Whip Jim Clyburn (D-S.C.) warned Democrats that they would suffer in 2010 if Republicans succeeded in forcing an ethics investigation into the relationships Murtha and other veteran Democratic lawmakers had with the PMA Group.

“If the Flake resolution is referred to the Ethics Committee, members can expect attacks ads to be run against them alleging members to be ‘under investigation by the House Ethics Committee,’” the whip’s staff warned members.

Pardon me, but OH NOEZ!   Congressional Democrats are those same people who pledged to "drain the swamp" and who blasted a "culture of corruption" dominating in Washington in the run-up to the 2006 election-- and there's a very good argument to be made that they actually won control of Congress off the back of concerns over it (and ethics, generally-- see myth number 4 here).  Isn't sticking to that promise, even when it's one of their own, a little more important than a few scary attack ads being run (which, incidentally, would be quite easy for Democratic members supporting an investigation into Murtha to explain away by saying something like: "yeah, he's a bad apple and that's why I did the politically tough but necessary thing in voting to investigate him,")?  Wasn't that kind of Democrats', er, point back in 2006?  Didn't they effectively argue that Republicans had promised to pursue good governance while in power, not get fat and happy and use their power to benefit themselves, their donors, their friends and/or their family members (like Jack Murtha appears to have done)?  I'm pretty sure that's exactly what they did.

And so are a few rogue Democratic members, including Ron Kind of Wisconsin, who incidentally is one Democrat I actually have some time for (he worked with Flake on farm reform):

“We need to have an institutional capacity to do some tough self-policing,” said Rep. Ron Kind, a Wisconsin Democrat who has voted in favor of the Flake resolution. “Our party needs to be careful not to appear hypocritical on this stuff.”

Quite.  It looks like Democrats Scott Murphy, Mike Quigley and Paul Hodes were with him, but perhaps unsurprisingly, per Politico "more senior Democrats expressed little enthusiasm for policing their colleagues."  Perhaps the longer you've worked with Jack Murtha, the less noteworthy, interesting and significant you find content in stories like this or this or even this.

Here's something for those "more senior Democrats" to ponder: Right now, this is just a web ad.  But by next year, there might be an revamped, up-to-date, harder-hitting version running on TV screens all across the country.  You'd expect that with Jim Clyburn citing TV ads as something Democrats, in their totality, should be concerned about, there would be more long-term thinking on hand that would signal to these guys that they might want to look into Murtha a little bit more and then shop that story of self-policing and good governance to the press and voters-- which, incidentally, I suspect a lot of people would actually praise, rather than punish, them for.

But sadly not, it seems.  Mark Kirk, who has also railed about Democrats allowing "$8 million directed to 12 pet projects for PMA clients" to remain in the 2009 omnibus spending bill, has criticized the majority for having "a complete lack of judgment." (He's been in similar territory before where the question of congressional pensions for public integrity felons is concerned, as I previously noted here).  That assessment seems about right here.  At the end of the day, I'm not complaining... but then I'm not a Democrat. ...
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President Obama campaigned hard on the theme of change last year, but the longer he occupies the White House, the more evident it is that there's not quite as much of that prized commodity on offer as a lot of Americans would like, myself inlcuded.

Exhibit number one for today: This item, from Huffington Post, which underlines that Obama is about to fire his first gay Arabic linguist.  Yes, indeed, Obama has the option of suspending gay discharges with a "stroke-of-the-pen":

Dan Choi, a West Point graduate and officer in the Army National Guard who is fluent in Arabic and who returned recently from Iraq, received notice today that the military is about to fire him. Why? Because he came out of the closet as a gay man on national television.

Some readers might think it unfair to blame Obama. After all, the president inherited the "don't ask, don't tell" law when he took office. As Commander-in-Chief, he has to follow the law. If the law says that the military must fire any service member who acknowledges being gay, that is not Obama's fault.

Or is it?

A new study, about to be published by a group of experts in military law, shows that President Obama does, in fact, have stroke-of-the-pen authority to suspend gay discharges. The "don't ask, don't tell" law requires the military to fire anyone found to be gay or lesbian. But there is nothing requiring the military to make such a finding. The president can simply order the military to stop investigating service members' sexuality.

An executive order would not get rid of the "don't ask, don't tell" law, but would take the critical step of suspending its implementation, hence rendering it effectively dead.

Apparently, this "critical step" is not one that the change-meister is prepared to take, which is incredibly unfortunate considering that during the campaign, Obama supporters writing in the NY Blade (link now dead, but text believed to be complete available here) praised him for "regularly" talking "about LGBT equality on the campaign trail, even when the audience was not LGBT-friendly."  Said these Obama supporters then, "Barack has been changing hearts and minds, and the visibility he has given to LGBT equality is unprecedented.  Barack’s commitment to LGBT rights is also manifest in his record of accomplishment, which extends throughout his 11 years in public office on every issue of concern to our community."

Every issue of concern to the LGBT community?  Listen, I'm not gay, but everyone I know who is thinks that the ability of a gay individual to serve his or her country in their armed forces is an issue of concern.  I think it's an issue of concern, too, and not just because this is a matter of basic fairness, where I believe basic, underlying concerns (e.g., homosexual fraternization) could be dealt with via ordinary conduct rules while still not preventing those who simply wish to serve from doing so.  I also think it's an issue of concern because, well, as Dan Choi's case exemplifies, the continued existence of Don't Ask Don't Tell is something that threatens to remove from our armed forces individuals with specialized, and highly-prized, skills-- like, say, speaking Arabic (a language spoken in a country where we continue to be engaged, not coincidentally, under the leadership of President Obama as we were under President Bush).  I understand that many in the military have objections to eliminating Don't Ask Don't Tell and that the President doesn't want to get tagged as a big liberal, but if there is one area of policy that really adversely impacts gay people, and very arguably to the detriment of us all, this would be it.  It would be nice, especially in the wake of this news regarding Dan Choi, to see the President make some movement to at least reform this policy, which feels increasingly outdated and outmoded-- especially given that the public, and military mood, on this issue seems to be shifting and we're simply not where we were in the first Clinton term of office anymore.

Conveniently, this leads us to example number 2: Government growth and outsized spending.  I spent plenty of time during the final Bush term in office complaining about his big-spending ways (sadly hard to miss after the relatively restrained Clinton years) and the fact that charts like this one, courtesy of the Cato Institute (and published back in October 2005) even exist:

So, you can imagine my general pleasure when I read things like this, from ABC's Jake Tapper and Sunlen Miller:

In formally introducing his $3.55 trillion budget to Congress today, President Obama emphasized $17 billion in spending cuts.

[...]

$17 billion is without question real money, and it means something, though within the context of the president's budget it's less than one half of one percent of the total budget.

And it's about 1.4 percent of the projected deficit for 2010 of $1.17 trillion.

And as the Wall Street Journal points out, the president's proposed "cuts are outweighed by proposals to spend more on an array of programs and regulatory functions." The budget for the Federal Railway Administration budget is increased, for instance, from $1.8 billion to $2.7 billion.

Whether or not $17 billion is a lot of money in spending cuts depends, of course, on what one compares it to -- and who's doing the comparing.

During the campaign last year, then-Sen. Obama discussed how Sen. John McCain, R-Ariz, railed against earmarks, and pointed out that the $18 billion in savings from eliminating earmarks paled in comparison to the $300 billion in tax breaks McCain proposed.

“Now, Senator McCain talks a lot about earmarks," Mr. Obama said during the third presidential debate in Hempstead, NY. "That's one of the centerpieces of his campaign. Earmarks account for 0.5 percent of the total federal budget. There's no doubt that the system needs reform and there are a lot of screwy things that we end up spending money on, and they need to be eliminated. But it's not going to solve the problem.”

It was a frequent Obama talking point, that $18 billion -- while not to be sneezed at -- is a trifle comparatively to the proposed McCain tax cuts, and to the budget in general.

“Earmarks account for $18 billion in last year's budget," Mr. Obama said on Fox News Sunday on September 28, 2008. "Senator McCain is proposing $300 billion in tax cuts. Now, $18 billion is important. $300 billion is really important.”

So is $3.55 trillion-- really, really important.  And so is $5 trillion, the amount of national debt ABC cites as having been racked up by Bush during his two terms in office-- the same Bush whose footsteps Obama seems to be following in, right now.  Per CATO's Chris Edwards, quoted in the ABC story, "President Obama is really continuing fiscal irresponsibility."

No kidding.  I've said it before, and I'll say it again.  First, Obama is delivering zero real change where anything much to do with fiscal policy is concerned.  He's a big spender, just like Bush was.  And he'll deliver higher taxes in the end, just like Bush, because of his big spending, even though he continually touts his commitment to widespread tax cuts-- remember, he proudly said, in summarizing his accomplishments during his first 100 days in office, "We have already... provided a tax cut to 95 percent of all working families."

So, then: Change?  The evidence continues to mount that where Obama is concerned, he's all talk and no action.

UPDATE: I see Rep. Joe Sestak was on Rachel Maddow's show tonight, making the point that just suspending Don't Ask, Don't Tell's implementation might not be such a smart move by Obama, in view of the US being a nation of laws and all that.  I get what he's saying, but I suspect that getting this policy repealed through the proper, full, governmental procedures isn't going to be a walk in the park-- and it's one that I have yet to be fully convinced Obama is treating as anything like a real priority.  I'd like to see some action, whether or not suspension is the ideal route to go. ...
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Apparently, it's Jon Huntsman.  Via US News & World Report's Political Bulletin:

US News Weekly, in its Washington Whispers column, reports, "When it comes to 2012, there's no potential Republican opponent who makes" former Barack Obama campaign manager David Plouffe "shake in his shoes," though Utah Gov. Jon huntsman (R) makes him a "wee bit queasy." Plouffe says, "I think he's really out there and speaking a lot of truth about the direction of the party."

This is, in my opinion, a pretty noteworthy thing.  Plouffe was the architect of a campaign that I have tremendous respect for, having worked on the opposing side of it last year.  If Huntsman worries him, even a little, that's something I'd say is a big endorsement for Huntsman as a could-be 2012 contender, and something that sets him well apart from the rest of the (presumptive) field.

Now, I know conservatives who don't like Huntsman much.  I must admit, I'm a little confused as to why, when some of those who I've heard express a dislike for him are people who say they prioritize fiscal concerns above all else and Huntsman got a 60/B rating from CATO last year on their fiscal report card-- a better score than all but four governors out of 46 assessed-- and a 59/B rating from CATO in 2006-- again a better score than all but four governors out of those assessed.  These conservatives will probably try to argue that Plouffe saying that Huntsman is speaking "a lot of truth about the direction of the party" is a way of Plouffe saying he agrees with Huntsman, philosophically, or that Huntsman is somehow one of those who's a party-attacker, as opposed to a party-builder.

I don't agree with that at all.  Huntsman has voiced some criticism of the GOP leadership, and he has staked out some positions on issues like the environment and civil unions that are different from those that many in the base of the GOP hold (something that is often read in and of itself by conservatives as an implicit criticism of them).  But ultimately, Huntsman is a conservative with some slightly different opinions on a couple of things that I think could enable him to expand the GOP tent in a way that a lot of other potential 2012 contenders could not.  His interest in the environment, support for family (even if not family in the conventional, heterosexual partnered sense of the word), and commitment to fiscal discipline (at least if you go with what CATO has to say on the subject) seems pretty similar, actually, to David Cameron-- the UK Tory leader who I voted for as party leader back in 2005, and who has totally revolutionized the party and put Labour in a bind.  That's something I'd love to see the GOP do to Democrats right about now, and Huntsman might just be the man for it.

UPDATE: Ben Smith notes that Plouffe has clarified that he did not in fact make the "queasy" comment cited above.  Sounds like the rest is all him, though. ...
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