“The Vote To Free The Hostages”: Unreasonable Conservatism Remains A Majority Proposition In The House Republican Conference
It was a foregone conclusion that the bill to end the manufactured fiscal crisis would sail through Congress once Ted Cruz foreswore a filibuster and John Boehner abandoned the “Hastert Rule.” The actual votes were anticlimactic, but still interesting.
The eighteen Senate Republicans who voted against the bill were far short of what it would have taken to sustain a filibuster, obviously. But still, the “nays” included all three senators thought to be mulling a 2016 presidential campaign (Cruz, Paul and Rubio), plus one previously mainstream senator facing a right-bent primary challenge (Enzi).
The 285-144 House vote showed why abandonment of the Hastert Rule was necessary. Actually, the 87 Republican votes cast for the bill (as against 144 GOP “nays”) was higher than most people anticipated. But it showed that unreasonable conservatism remains a majority proposition in the House Republican Conference.
The only “yea” vote that surprised me was that of Rep. Tom Cotton of Arkansas. But I’m guessing he really, really wanted to get money fully flowing to the Pentagon. More predictably, all three House members from Georgia running for the Senate voted “nay,” as did the putative GOP Senate candidate from Louisiana, Bill Cassidy. Shelley Moore Capito, the likely GOP Senate nominee from WV, voted for the bill.
At TNR Nate Cohn has some interesting insta-analysis of the GOP vote patterns in the House, noting that it was a lot like the “fiscal cliff” vote in January.
The underlying divisions are similar to the fiscal cliff vote, as well. Last January, commentators marveled at the outlines of a GOP civil war, between north and south, tea party and establishment. Tonight, red state and Southern representatives voted overwhelmingly against the Senate compromise: 27-91 in the red states, 25-88 among Southern representatives. Republicans from the Northeast and Pacific voted “yes” by 30-16 margin; the blue states voted “yes,” 32-17.
Cohn also notes that House GOPers with distinctly less ideologically conservative voting records and those from very marginal districts voted overwhelmingly for the deal. But any way you slice it, the majority of the Conference voted to continue a government shutdown and a debt limit threat that were not working very well for the GOP or for the country.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, October 17, 2013
“The President’s Pivot”: The Tactical Move To Immigration Reform Is Brilliant, And Republicans Know It
“Thus it is that in war the victorious strategist only seeks battle after the victory has been won, whereas he who is destined to defeat first fights and afterwards looks for victory.”
That quote, from Sun Tzu’s ancient Chinese treatise “The Art of War,” perfectly captures President Obama’s strategic victory over Tea Party members of Congress on the government shutdown and the debt ceiling debate. It also explains his immediate pivot to another topic that Tea Partyers hate and over which their obstinacy is likely to get the party hammered again: comprehensive immigration reform.
This is a brilliant tactical move on the president’s part. And Republicans know it.
As the G.O.P. was nearing its moment of collapse on the shutdown and debt ceiling, Representative Raúl Labrador, Republican of Idaho, said, “I think it’d be crazy for the House Republican leadership to enter into negotiations with him on immigration.” He continued: “And I’m a proponent of immigration reform. So I think what he’s done over the last two and a half weeks — he’s trying to destroy the Republican Party. And I think that anything we do right now with this president on immigration will be with that same goal in mind: which is to try to destroy the Republican Party and not to get good policies.”
The conservative columnist Charles Krauthammer laid out the president’s calculus more bluntly on Fox News: “With immigration, he wins either way. I’m not sure he thinks he can get it passed, seeing the resistance among the Republicans to the deal over the budget. I think he knows he’s not going to have a good chance of getting immigration through, but he thinks — and he’s probably right — that he can exploit this for the midterm election as a way to gin up support, for the Democrats to portray the Republicans as anti-immigrant, anti-Hispanic, etc.”
Republicans have a tough choice.
They can ride shotgun once again with the politically suicidal Tea Party faction, a group that the Pew Research Center for the People and the Press found this week to be “less popular than ever.” They can allow the most strident voices on the far right that oppose comprehensive immigration reform — Rush Limbaugh has likened it to the Republican Party’s “authoring its demise” — to direct their path and further alienate Hispanic voters, who are increasingly coming to see the party as an unwelcoming place. Mitt Romney lost the Hispanic vote by 44 points last year, and the Republican National Committee’s own autopsy on that loss surmised:
“If Hispanic Americans perceive that a G.O.P. nominee or candidate does not want them in the United States (i.e., self-deportation), they will not pay attention to our next sentence. It does not matter what we say about education, jobs or the economy; if Hispanics think we do not want them here, they will close their ears to our policies.”
Or Republicans can take the less likely path and demonstrate that they’ve been cowed enough to move ahead on a major piece of legislation that is supported by the majority of the American people — a July Gallup poll found that 71 percent of Americans believe that passing immigration reform is important. And that would be good not just for the president’s legacy but for the health of the country as a whole.
In a 2012 paper published by the Cato Institute, Raúl Hinojosa Ojeda, director of the North American Integration and Development Center at the University of California, Los Angeles, used computing models to estimate the following:
“Comprehensive immigration reform generates an annual increase in U.S. G.D.P. of at least 0.84 percent. This amounts to $1.5 trillion in additional G.D.P. over 10 years. It also boosts wages for both native-born and newly legalized immigrant workers.”
Comprehensive immigration reform is the right thing and the thing that Americans want. But the far right is hardly concerned with what’s right and has little appetite for agreeing with the will of the majority of the American people (despite talking ad nauseam about standing up for the American people).
The far right is angry at the government and the man at the top of it. According to a Pew Research report released Friday: “Anger at the federal government is most pronounced among Tea Party Republicans. Fully 55 percent of Republicans and Republican-leaning independents who agree with the Tea Party say they are angry with the federal government — about double the percentage among non-Tea Party Republicans (27 percent) and Democrats and Democratic leaners (25 percent).”
They have been blinded by that anger. The president knows that. And he knows that blind soldiers don’t often win battles. In choosing to pivot to immigration reform, he has created a win-win scenario for himself and the Democrats. Clever, clever.
By: Charles M. Blow, Op-Ed Columnist, The New York Times, October 18, 2013
“Captain Of The USS Republican”: Raking In The Money, Ted Cruz Discovers The Fringe Benefits Of Failure
The recent political turmoil in Washington was multifaceted and involved quite a few personalities, motivations, and working parts. No one person was ultimately responsible for the entire nightmare.
But if we were to focus in on one main culprit, it’s safe to say Sen. Ted Cruz (R-Texas) would lead the list of suspects. He spent the August recess demanding his party follow his shutdown plan; he offered leadership to House Republicans; the right-wing senator even made himself the public face of this fiasco with a 21-hour speech that served no legislative purpose, but made it easy for Ted Cruz to celebrate his fondness for Ted Cruz.
The freshman Republican became so notorious that when he campaigned for Ken Cuccinelli in Virginia a couple of weeks ago, the gubernatorial hopeful didn’t want any photographs taken of the two of them together.
But let’s not miss the forest for the trees. Cruz led his party into a ditch and drew the ire of Republicans who blame him for his misguided crusade, but the far-right Texan appears to still be in the midst of a long con.
If you were curious, talking on television for 21 straight hours is very lucrative. Over the last quarter, Ted Cruz’s still-young political action committee pulled in $797,000 during the period that included his extended C-SPAN advertorial. It’s nearly twice what Cruz pulled in the quarter prior. […]
His October report, which covers July 1 to September 30, notes that his PAC has $378,000 on-hand after the nearly $800,000 haul, money that will be used to support conservative candidates and issues close to Cruz’s heart.
Cruz isn’t making many friends among his Senate colleagues; he has no prospects for actually passing bills; and he’s cultivated a public reputation as a dangerous extremist. This may seem like a poor combination, but the senator clearly doesn’t see it that way.
While pushing his party over a cliff, Cruz has also positioned himself as a guy capable of winning straw polls, quickly raising a lot of money, and collecting a massive new database of conservative donors and activists – which may come in handy if a certain someone intends to launch a bid for national office in a couple of years.
Cruz’s party shut down the government and caused a debt-ceiling crisis for reasons that still don’t make any sense, leading to a surrender in which Republicans gained nothing. In fact, it was worse than nothing – the GOP has seen its support collapse, ending up with a deal that could have been better for the party had it been less ridiculous weeks ago.
But from Cruz’s perspective, these developments, while unfortunate, are a small price to pay for advancing his personal ambitions.
By: Steve Benen, The Maddow Blog, October 17, 2013
“An Alternate Bizzaro Universe”: Ted Cruz’s “American People” Remain Imaginary And Elusive
Give Ted Cruz this much: He remains unbowed in the face of both substantive defeat and public opinion, which he ceaselessly claims to have on his side.
For example, yesterday Cruz addressed the press (the man seems to only communicate in formal speeches – can you imagine dining with him?) on the shutdown and its conclusion, declaring the whole thing a massive expression of the will of “the American people.” He said:
Unfortunately, once again, it appears the Washington establishment is refusing to listen to the American people.
It is unfortunate that Washington is not listening to the people.
And I want to commend the House of Representatives. The House of Representatives has taken a bold stance listening to the American people.
Months ago, when the – when the effort to defund “Obamacare” began, official Washington scoffed – they scoffed that the American people would rise up. They scoffed that the House of Representatives would do anything, and they scoffed that the Senate would do anything.
We saw, first of all, millions upon millions of Americans rise up all over this country. Over two million people signing a national petition to defund “Obamacare.” We saw the House of Representatives take a courageous stand listening to the American people …
As I have argued before, it raises the question of precisely which “American people” Cruz is speaking for, because it’s not the ones who are answering pollsters. For example, an ABC News/Washington Post poll released Monday found that 74 percent – 74 percernt! – of Americans disapproved of the way Congressional Republicans were handling the budget negotiations, an 11 percent increase from a few weeks earlier. That came after an NBC News/Wall Street Journal poll last week found only 24 percent of those surveyed approving of congressional Republicans – a result which Republican pollster Bill McInturff (who along with Democrat Peter Hart conducted the survey) said made it, “among the handful of surveys that stand out in my career as being significant and consequential,” along with polls taken in the wake of 9/11, Hurricane Katrina, the Lehman collapse and the last debt ceiling crisis. (Cruz tried to “unskew” the NBC/Wall Street Journal poll, but was unsuccessful.)
Further, polls have shown that Obamacare has become more popular and that the intensity among its opponents has ebbed. And while polls show that more Americans disapprove of Obamacare than like it (though those numbers are deceptive if you don’t take out the people who disapprove because the law doesn’t go far enough), surveys also show that most Americans prefer to have Congress work to improve the law rather than repeal or defund it, a la Cruz.
And all of this after polls showed overwhelming numbers of Americans disapproved of shutting down the government in order to win policy concessions from the other side … which brings me to Cruz on Fox News last night. “But we’ve also seen a model that I think is the model going forward to defeat Obamacare, to bring back jobs, economic growth, to abolish the IRS, to rein in out-of-control spending,” he said. A model going forward – that’s right folks, Ted Cruz enjoyed this shutdown so much that he wants to do it again.
Presumably he’ll claim then to be acting in the name of the American people as well. Ted Cruz was elected from Texas, but it’s clear he really hails from some bizarro alternate universe. Where else could Obama winning a comfortable re-election and poll after poll after poll showing that Americans like neither shutdowns nor the party behind the specific shutdown that just ended all add up to a by-any-means-necessary mandate to pursue Cruz’s narrow right-wing agenda?
By: Robert Schlesinger, U. S. News and World Report, October 17, 2013
“Cloaked In Secrecy”: The Myth Of The Medical-Device Tax
In the last few days of negotiations in Congress, repeal of the Affordable Care Act’s tax on medical devices emerged as a key Republican demand. The medical-device industry waged an intense lobbying campaign — even garnering the support of many Democrats who favored the law — arguing that the tax would stifle innovation and increase health care costs.
This argument is doubly disingenuous. Not only can the medical-device industry easily afford the tax without compromising innovation, but the industry’s enormous profits are a result of anticompetitive practices that themselves drive up medical-device costs unnecessarily. The tax is a distraction from reforms to the industry that are urgently needed to lower health care costs.
The medical-device industry faces virtually no price competition. Because of confidentiality agreements that manufacturers require hospitals to sign, the prices of the devices are cloaked in secrecy. This lack of transparency impedes hospitals from sharing price information and thus knowing whether they are getting a good deal.
Even worse, manufacturers often maintain personal relationships (sometimes involving financial payments like consulting fees) with physicians who choose the medical devices that their hospitals purchase, creating a conflict of interest. Physicians often don’t even know the costs of the devices, and individual physicians often choose devices on their own, which weakens a hospital’s ability to bargain for volume discounts.
Such anticompetitive practices help generate a wide variation in the prices of medical devices — and contribute to higher prices in general. For example, the Government Accountability Office found that prices for cardiac implantable medical devices in the United States vary by several thousand dollars. And even the lowest-priced devices in the United States are expensive compared with those in other developed countries. According to the consulting firm McKinsey & Company, the United States spends about 50 percent more than expected on the top five medical devices, compared with Europe and Japan. McKinsey calculates that this amounts to $26 billion in excessive spending each year. Medicare, private health insurers and patients end up paying these inflated prices.
Excessive prices fuel enormous profits — profits that dwarf both the medical-device tax and the industry’s investments in research and development. Consider the device division of Johnson & Johnson, which in 2012 had an operating profit of $7.2 billion. By the company’s own estimate, the device tax would amount to at most $300 million, and its investment in research and development amounts to only $1.7 billion.
There are several ways policy makers could lower device costs. The first step would be to end the anticompetitive practices that prevent hospitals from getting the best deals. Senator Charles E. Grassley, Republican of Iowa, has sponsored legislation that would foster transparency by posting online price information for implantable medical devices.
In addition, instead of simply paying hospitals based in part on what they have spent on devices, Medicare should force manufacturers to compete for business based on a product’s price and quality.
Medicare should also pay hospitals a single lump sum for all of the associated costs of a given procedure (like a hip replacement). This approach, known as “bundling” the costs, would create incentives for hospitals to lower device costs. Savings should be shared with the physicians, so that their incentives are aligned with the hospital’s.
Bundling has been used successfully in pilot programs. Under Medicare’s Acute Care Episode Program — which bundled payments for cardiac and orthopedic procedures — physicians worked together to choose high-quality, cost-effective devices. Baptist Health System in Texas, which participated in the program, used clinical evidence to choose devices and negotiated lower prices for both Medicare and non-Medicare patients.
States could adopt similar payment reforms for private insurance and their Medicaid programs. In Arkansas, the Medicaid program and private payers — including Walmart — have collaborated to adopt bundled payments for several procedures, including hip and knee replacements.
To complement these efforts, the new Patient-Centered Outcomes Research Institute, a nongovernmental body created by the Affordable Care Act, should pay for research that compares the effectiveness of devices so physicians can make informed choices. (Three years into its existence, the institute has initiated few, if any, studies of medical devices.) Medicare or the Food and Drug Administration should also require the use of registries that track when devices fail.
Currently, medical-device manufacturers allocate only a sliver of profits to research and development and often focus on “tweaks” to existing devices, without providing any evidence that they are of better quality. Competitive pressures from public and private payers would provide incentives for the industry to become more innovative, producing technologies that actually lowered costs and offered truly advanced breakthroughs.
Instead of using its clout to lobby against the device tax — which helped foment opposition to the Affordable Care Act — the medical-device industry needs to share the responsibility of lowering costs for patients, businesses and taxpayers.
By: Topher Spiro, Op-Ed Contributor, The New York Times, October 16, 2013
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