Taking Note

A Hundred Days of Shattering Shibboleths

President Obama's own accounting of his first hundred days in the White House--a journalistic mile-marker ever since the feverish output of Franklin Roosevelt's early months in office--was telling.  He devoted less than a tenth of his 100th day press conference statement to his foreign policy initiatives.

He didn't need to dwell longer--and not just because the public's interest is understandably focused on the crises at home.  What is most striking is that Obama's wide-ranging reversals of conservative policies of unilateralism, intransigence, and denial have gone virtually unchallenged, earning wide applause at home as much as abroad.  The audience for the bilious right's fulminations is no wider than its own zealots.

Health Care Reform and The Filibuster

Rahm Emanuel has warned that when gauging President Obama “Republicans and others have made a mistake: He has an open hand, but it's a very firm handshake."

I don’t usually think of Rahm Emanuel as a phrase-maker, but in this case, he has hit upon a superb metaphor for the president’s willingness to reach out to his opponents, and invite them into an honest  bipartisan dialogue-- while making it clear that he is not willing to compromise his bedrock values.

The president displayed his inner steel last Thursday when he told Republicans that he will not let them use a filibuster to veto his health care proposal. The threat of a filibuster had hung over the administration’s health care initiative until last week, when President Obama persuaded Senate Democrats to follow the House and include “reconciliation protection” for health care in the budget bill.  This means that Republicans cannot  block reform by reading the phone book---and Democrats need only a simple majority (50 votes ) to pass health care reform in the Senate.

Not So Super-majorities

The announcement that Senator Arlen Specter of Pennsylvania was switching parties brought the Democrats to within an eyelash of a filibuster proof majority in the Senate. Most Americans probably figure that a plain old majority ought to be enough to pass legislation and do the public’s business. But that’s not the case in the upper house of Congress, where 60 votes are needed to end debate before legislation can be voted up or down.

When I was a boy, the notion that 60 senators were needed to do anything in Washington arose mainly over the issue of Southern filibusters to stop Civil Rights legislation. These often very senior southern lions, some of them outright white supremacists, regularly brought the business of the Senate to a halt rather than see voting rights enacted or Jim Crow laws struck down.

Public Backs Obama at 100 Days

This Wednesday, April 29, marks the 100th day of Obama’s presidency. And the reaction from the public is an overwhelming thumbs up. In a just-released Pew Research Center poll, the president’s favorability rating stands at 73 percent, with just 24 percent viewing him unfavorably.

This drives conservatives absolutely batty. How can so many people approve of him when Obama is pursuing a big government, big spending “socialist” agenda? He must be casting some strange spell over the American people to get such high ratings.

A simpler explanation is that the public likes his policy approach and feels he’s on their side. When an early April CBS/New York Times poll asked whether Obama cares more about protecting the interests of ordinary people or of large corporations, 71 percent thought he was on the side of ordinary people, compared to a mere 17 percent who thought he favored large corporations.

Obama Plants the US flag at the United Nations

President Obama has dramatically re-established American relations with the UN in his first 100 days. His acclaimed multilateral outlook on international relations, his willingness to listen to foreign leaders rather than lecture them, his admission of "mistakes" by the US on issues like torture, the economy, the Iraq war, and other global matters, and his general popularity around the world, have created an entirely new atmosphere in the United Nations building.

Experimenting with Medicare

This week, the Senate Finance Committee hosted the first of three roundtable discussions on health care reform. This session honed in on reimbursement and delivery reform; future roundtables will focus on expanding health coverage to all Americans  (May 5) and financing health care reform (May 14). "Medicare is the big driver here,” declared Finance Chair Max Baucus (D-MT), and “How to scale it up” will be one of the key questions, he said, but “Medicare will be a big part of that solution.”

As I have suggested in the past, Medicare is likely to become the place where policymakers can experiment with wringing some of the waste out of our health care system, so that we can provide affordable, sustainable, highly effective care for everyone. In fact, Medicare already has embarked on pilot projects that provide incentives for health care providers to collaborate and become more efficient. The projects that work are likely to be expanded and become part of national health care; those that don’t work can be quickly discarded. During the roundtable discussion, many suggested that Medicare needs more freedom to innovate, additional funds, and a mandate to launch  more pilot projects.  Ultimately, a new, improved Medicare could become a model for a public insurance option. National health care reform does not have to wait on Medicare reform; I suspect that policy-makers will be working on both, simultaneously, over the course of President Obama’s first term.

Public Backs U.S.-Cuba Relations

President Obama last week eased restrictions on the ability of Cuban Americans to visit and send money to family in Cuba—the first significant change in U.S. policy toward Cuba in decades. The decision reverses the particularly hard-line stance of the Bush administration, a move by Obama that apparently has the full backing of the American public.

Consider these results from a WorldPublicOpinion.org early April survey on Cuba policy and U.S. public opinion. The survey asked respondents which position was closest to theirs given recent leadership changes in Cuba: that it was “time to try a new approach to Cuba, because Cuba may be ready for a change” or that since the Communist Party is still in control, the United States “should continue to isolate Cuba.” By a 59-to-39 percent margin the public backed the time-for-a-change approach.

The American people are even more supportive of the specific moves made by President Obama last week. They back his easing of travel restrictions for Cuban Americans by an overwhelming 79-to-19 percent margin.

Mammography Screening: A Double-Edged Sword?

I still remember the sound of her voice on the phone: scared, frustrated and looking for answers. That summer I was working as a patient representative at a New York City hospital when I got a call from a middle-aged woman who had undergone a routine mammogram two weeks earlier. She still hadn’t received the results. When the woman called the imaging center, she was told that the radiologist had not yet provided his report because he wanted to see films from her last mammogram in order to make a comparison. This simple request created great anxiety for my client:

Why was it taking so long to get results? Had the radiologist seen something suspicious? Was this a sign that something was really wrong? The woman then told me that several years before, a doctor had seen an anomaly on her mammogram and that had led to more invasive testing, including further imaging and a surgical biopsy. The lesion ultimately turned out to be benign, but the experience had been extremely stressful and made her yearly mammograms a dreaded procedure.

A Visit to Politico

In Washington, Politico is now an established and respected competitor in news and comment about its subject. Lots of media entries in the Internet age have started strong and faded when they were unable to convert online audiences into cash flow or to find a buyer who could. Politico seems to be different, and it may have one of the vaunted new models for journalism so desperately being sought these days.

            Frederick J. Ryan, Jr., the CEO of Politico, startled me in a brief corridor chat by calling it “this newspaper,” which for people in Washington it is. Politico appears in print on a daily basis when Congress is in session, otherwise weekly, and is distributed free to its intended local readers. Last Tuesday, the paper was twenty-eight pages, with ads from Chevron, Boeing, Novartis, and Kaiser Permanente, among others. Living in New York, I am a Politico reader only on the Web, so the importance of its print product was a surprise. But I knew the star bylines and was familiar with the energy and tone of their pieces.  Mike Allen’s dawn e-mail, Playbook, a summary of news stories and gossip appearing in morning media, quickly has become a popular notice board for the politically minded chattering classes and is currently sponsored by Starbucks, which pays what I’m told is real money.

Earning a Living as a Creative Genius

The age of free information is upon us, and with it, the seeds of destruction of the labor force that creates, assembles, and disseminates ideas.  The market is not providing alternatives.  This is a job for government.

“Public Goods” is a technical expression in economics.  It refers to goods that either are available to everyone or to no one.  More and more people can enjoy public goods without increasing the cost of providing them.  The best examples are things like clean air, public art, and national security.  (Not surprisingly, the line between public goods and scarce goods is often hard to draw.) 

Markets do a bad job providing public goods because either people cannot be excluded from enjoying them, in which case there is no profit in producing them, or people are excluded even though it would cost no more to let them enjoy the goods.  Public goods are a classic example of market failure, as taught in Economics 101.