TIME Veterans

VA Chief Eric Shinseki (Still) Must Go

Eric Shinseki
Veterans Affairs Secretary Eric Shinseki pauses while testifying before the Senate Veterans Affairs Committee hearing to examine the state of Veterans Affairs health care on Capitol Hill in Washington, May 15, 2014. Cliff Owen—AP

The VA is broken. It’s past time to fix this shameful bureaucratic tragedy

Back at the turn of the 21st century, when he left Washington to become president of the New School university in New York City, former Senator Bob Kerrey learned a little something about the ethos of Veterans Affairs. Kerrey, a Medal of Honor recipient who lost part of a leg in Vietnam, needed to get his home address changed. He had called his bank and settled the matter in 10 minutes. He called the VA and spoke to a hostile and not very helpful receptionist. He spoke to the receptionist’s supervisor, who told him, “You’re going to have to come in.” So Kerrey went to the VA office in New York. The receptionist again wasn’t very helpful. Kerrey pointed out that he was only talking about an address change. The receptionist said, “Talk to one of them,” pointing to customer “service” employees sitting at desks labeled A and B. Desk C was vacant. Kerrey went to Desk A, where he was told, “That’s handled by Desk C.” Kerrey asked when the occupant of Desk C was returning. “I don’t know,” said Desk A. Kerrey went over and sat at Desk C for a long while, and then a longer while. He spoke to the supervisor, who had no idea where Desk C was and told Kerrey, “Come back tomorrow.”

“You gotta be kidding,” Kerrey said, or perhaps yelled. It took 12 days to get his address changed.

I’ve heard far more serious VA horror stories ad nauseam in recent years. I know of at least one young Marine who committed suicide while waiting—months—for his medical records to be transferred from Los Angeles to Houston. I’ve also heard stories of heroic treatment performed by devoted VA doctors, nurses and counselors, but those often occurred after their patients endured a Kafka-esque struggle with the VA’s bureaucratic gate-keepers. You might expect that the system, which is staffed largely by older veterans, would have adapted with alacrity to the crisis posed by the wave of wounded Iraq and Afghanistan veterans over the past decade. But the VA’s response has been stagnation, and worse. It is now clear that there was a conscious, and perhaps criminal, effort to camouflage the time veterans had to wait for service in Phoenix and at other VA facilities. It is alleged that 40 veterans died waiting for service in Phoenix; whether or not that proves accurate, we’re facing a moral catastrophe.

The question is, How do we change this situation? The simple answer is leadership, which is why some have called (as I did last year) for VA Secretary Eric Shinseki to resign. By all accounts, Shinseki is a fine man who has spent nearly six years lost in the system. An effective leader would have gone to Phoenix as soon as the scandal broke, expressed his outrage, held a town meeting for local VA outpatients and their families—dealt with their fury face-to-face—and let it be known that he was taking charge and heads were going to roll. Instead, Shinseki intoned the words “mad as hell” at a congressional hearing. And White House chief of staff Denis McDonough said the President was “madder than hell” about the situation. Does anyone actually find this convincing?

The President cares deeply about the troops; he visits the wounded in the hospitals all the time; it’s just not his style to make a public deal of it. But he has been sadly ineffective on the veterans–health issue. The benefits system is still rigged against recent veterans, who go to the end of the line with their claims. Five years ago, Obama promised a unified electronic records system so that a soldier’s medical history would follow him or her seamlessly from active duty to the VA, but it still hasn’t been implemented because of trench warfare between the Pentagon and the VA. More than a billion dollars has been spent on the project. A senior Administration official told me a year ago that a solution was weeks away; now the Administration is promising a new system by 2016. The President could have solved this problem yesterday, by cracking heads—and selecting either the existing VA or Pentagon electronic records system. (Believe it or not, the VA system is pretty effective but not up-to-date.)

The problem of bureaucratic stagnation at the VA (and throughout the rest of the government) could be addressed as well. Think about the lazy clerks Bob Kerrey faced. Why were they so callous? Because under the existing, antiquated civil-service system, they face practically zero threat of being fired. The President could ask for a temporary waiver of civil-service rules to clean up the mess at the VA, but that seems politically impossible. Government accountability is a popular mantra—but you can’t have accountability unless everyone, including Desk C, is held to account.

TIME 2014 Election

California’s New Jungle Primary System

Mike Honda
Liberal lion Mike Honda in D.C., where he has support from the Democratic establishment. He has served seven terms in Congress but faces challenges from within his own party Jose Luis Magana—AP

All bets are off in California's congressional races as multiple candidates from the same party face off

“I’m Guessing,” says Dan Schnur, who is running for California secretary of state, “that not many of you lie awake at night wondering what the next California secretary of state will do.” There is laughter from the crowd of maybe 30 voters. And you, too, dear readers–especially those of you who don’t even live in California–may be wondering why a candidate for a decidedly obscure political office is worthy of your attention.

Well, part of it is that Dan Schnur is an interesting guy, a longtime consultant to moderate Republicans like Arnold Schwarzenegger and John McCain. But he isn’t a Republican anymore. He’s running as an Independent. “I’m in favor of marriage equality and lower taxes,” he begins. “I’m tough on crime and pro-choice. I’m for immigration reform and for using test scores as a valuable measure of students’ progress. Yes, the reason that I’m running as an Independent is that neither party will have me.”

But that’s not exactly accurate. He’s running as an Independent because there were two political reforms enacted during Schwarzenegger’s time as governor of California. They were below the radar but startling, the sort of reforms that are near impossible because incumbent politicians usually block them–but they were passed by public referendum and initiative in 2010, and Schnur was one of those at the heart of the campaign to get them enacted.

The reforms are ingeniously simple. There is no more gerrymandering in California, no more congressional or state legislative districts tailored to the needs of the incumbents or the majority political party. District lines are now drawn by an independent commission to reflect actual community borders. (The commissioners are forbidden by law from knowing where the incumbents live.) Second, primaries are now multipartisan: the top two vote getters, regardless of party affiliation, face off against each other in the general election. Schnur co-chaired the Voices of Reform project on redistricting. “I wasn’t too involved in the top-two primary reform,” he says. “I didn’t think it would make much difference … but I’ve learned: this could be enormous.” Schnur and his colleagues may have actually created an electoral system that favors centrists rather than politicians who play to their party’s base. On June 3, California will go to the polls in what politicos have taken to calling the Jungle Primary.

California’s Fourth Congressional District is a perfect primer for the curiosities of the Jungle. Tom McClintock, 57, is the three-term incumbent and has long prided himself on his “constitutionalist” orneriness. He is, in other words, a Tea Party Republican. His district, in the Central Valley and foothills, is very conservative but perhaps not as extreme as McClintock is. He is, for example, in favor of amnesty for Edward Snowden, the NSA leaker, because Snowden helped expose the criminal proclivities of the federal government and “I’d rather have him home talking to us than over there talking to the Russians.”

At a well-attended Saturday-afternoon meeting in the town of Mariposa, near the entrance to Yosemite National Park, McClintock endorsed a candidate for county supervisor and then addressed the crowd, many of whom wore cowboy hats and sported some elaborate facial hair. They were all het up over the federal government and the “left-wing environmentalists,” as McClintock described them, calling the federal tune in Yosemite. Some of their complaints sounded reasonable: a local toad was about to be labeled “threatened,” which would further limit the local water supply (there’s been a terrible drought in California)–but the toads were dying out, according to the locals, because the feds had stocked the lakes with trout, which ate the tadpoles. The feds were also proposing to close down stables and rafting businesses along the Yosemite waterways.

McClintock is a smart politician who knows the issues, knows what his constituents care about and can make it seem as if he’s as angry as they are. He takes lonely–his opponents say obstructionist–stands against the various agencies of the Department of the Interior. He “speaks truth to power,” as he told the folks in Mariposa. In the past, he didn’t have many electoral cares; the Democrats have never had much of a chance in either the old or new Fourth District. But now McClintock has to worry about Art Moore, who is also a Republican.

Moore, 36, is a razor-sharp recent combat veteran, an Army major returned to his hometown of Roseville, the most populous community in the Fourth District. He is a graduate of West Point who served tours in both Iraq and Kuwait. He is also, however, a stone-cold neophyte who hasn’t really been to political boot camp yet. He is, he says, “a conservative,” and he checks the appropriate boxes on most conservative issues, like Obamacare–but he also is “a bit more libertarian” than McClintock on social issues like gay marriage and abortion. Most important, though, is his style: he’s the opposite of McClintock’s lone gunslinger. “You’ve got to sit down and negotiate with those you don’t agree with,” he says. “[McClintock] has a perfect conservative voting record, but what has he got done? He voted to shut down the federal government–to close Yosemite–which really hurt this district. I’m in favor of building coalitions and seeing if we can make some progress on the issues.”

Moore admits that he would not have run under the old system. McClintock has the party base locked up and the power of incumbency. But if Moore can make it into the general election against McClintock, he may be able to access independent and moderate Democratic voters as well as his brand of conservative Republicans. “In the Jungle Primary, everybody has to run to the center,” says Fred Keeley, a former state rep from Santa Cruz who co-chaired the Voices of Reform project with Schnur, “because that’s where the votes are.”

McClintock claims not to be worried about Moore. He tells me that his “most substantial opponent” in the Fourth District is an Independent named Jeffrey Gerlach. It’s a lovely tactic to pretend that Moore doesn’t matter and a sign that uniprimary politics can get pretty interesting: a Republican opponent like Moore, who might appeal to moderates in November, when more people are paying attention, is McClintock’s worst nightmare in the Jungle.

Indeed, across the state in Silicon Valley, there has been an outbreak of electoral weirdness in the 17th Congressional District–which, in some ways, is a mirror image of the race in the Fourth: Mike Honda, a traditional labor liberal, is opposed by a more moderate Democratic newcomer named Ro Khanna. Khanna, 37, is an Indian American, an intellectual-property lawyer who worked in Barack Obama’s Commerce Department and has close ties to the President. He has also reportedly raised $3.7 million–far more than Honda–from Silicon Valley tech titans, who are just beginning to flex their political muscles (much as Hollywood did during the Vietnam War). Khanna is an impressive candidate, fluent on every issue and, in some cases, downright courageous: he is willing to challenge the public-employee unions–all of which support Honda–on issues like accountability and pension reform. Most of the major newspapers in the district have endorsed Khanna.

But the 17th District also has a semiplausible third candidate–a Republican named Dr. Vanila Singh, 43, a young and attractive professor of anesthesiology at Stanford University Medical School. Singh is a neophyte and can seem foggy on the issues, but she has positioned herself cleverly–she’s another social liberal, and she’s willing to negotiate with the Democrats about the Affordable Care Act. In fact, since about 25% of the district votes Republican, she might pose a credible primary threat to Khanna, the Democratic moderate. And so, after she declared her candidacy, there was a sudden flowering of old-style urban ward politics in and around San Jose. Suddenly, Singh had two Republican challengers–one named, confusingly enough, Vanish Singh Rathore (who was eliminated from the ballot because the signatures on his petitions were not remotely plausible); the other, Joel Vanlandingham, offered petitions that included signatures from Khanna supporters.

Khanna denies any hand in this. “I would have to be pretty stupid to get involved in that sort of thing,” he says. “I mean, Vanlandingham was really tough on me in the League of Women Voters debate.”

There are some who say that the Jungle will cause of lot of rumbling but no real results. “The rubber meets the road when the moderates go to Congress,” says Samuel Popkin of the University of California at San Diego. “The evidence suggests they stick with the party line.” The evidence is skimpy, though–just the 2012 election, when the Jungle was brand-new and most politicians weren’t completely aware of its possibilities yet. Some felt the traditional pull of partisan loyalty and chose not to challenge their party’s stalwarts.

Khanna was one such in 2012, when he chose not to challenge the venerable Representative Pete Stark, a devoted liberal and the only admitted atheist in the House. Another young Democrat, Eric Swalwell, made that race and beat Stark, which sent a signal throughout the state that the Jungle was open for business: you could challenge incumbents of your own party and maybe even win.

Honda seems a bit mystified by all that has happened. His is a classic American story. He spent part of his youth imprisoned in a Japanese-American internment camp in Colorado during World War II. He was inspired, not embittered, by the experience. He became a teacher and then a school principal, then commenced a public life that culminated in seven terms in Congress. His campaign office is in a Service Employees International Union hall. He greets me wearing jeans and cowboy boots and a red, white and blue Democratic donkey tie.

He sees his career as many incumbents do: a list of local projects funded, of ideological battles fought–in his case, the relentless pursuit of social justice and civil rights. He remembers helping get a nanotechnology bill passed in 2003 at the behest of Silicon Valley, but now the techno-wizards have abandoned him in favor of Khanna. “I’m an orchardist,” he says. “That nanotechnology bill planted the seeds for the trees that are bearing the fruit in Silicon Valley now. But I guess no one remembers those who plant the trees.”

It is hard not to have sympathy for Honda, but the political orchard he and his generation planted was poisoned over time by partisanship and paralysis, and now it has been replaced by a jungle. We’ll see what sorts of glorious fruits and subtle poisons the Jungle brings forth.

TIME

Matt Miller’s Truth Campaign

I’ve hesitated writing about my friend Matt Miller’s Congressional campaign in California’s infamous 33rd District on the west side of Los Angeles because, well, he’s a longtime wonk-friend of mine. His candidacy is probably a longshot, although he has been endorsed by the LA Times. He’s an enlightened amateur, a veteran of Bill Clinton’s Office of Management and Budget and a truly creative thinker when it comes to public policy.

And he’s worth your attention because he’s running that rarest of things: a truth campaign. He’s telling the truth about what he believes, no matter how unpopular it is–or worse, in his case: Complicated. He doesn’t fudge his position on the issues–in part because his positions have been elaborated in several (readable) policy books. And in more than a few cases, his proposals are unique, or nearly so. Certainly, they’re not the sort of positions normal politicians are willing to take.

Take Miller’s reaction to today’s report that climate change is already have a profound effect on our weather. He simply went to his library of policy papers and proposed the following: a carbon tax and dividend system. What’s that? Well, there’s been endless discussion about how to discourge people from using carbon-powered energy (at least, among those Democrats and Republicans who are not climate-change deniers). There have been all sorts of complicated things proposed, like a cap and trade system–which I will not explain here–in order to hoodwink the public into thinking they’re not actually being taxed for the carbon they consume.

Miller has taken the simplest possible route. He taxes carbon directly at the source, a gradually increasing system that eventually amounts, after ten years, to $1 per gallon of gas. But he returns the proceeds–the dividend–right back to the public in a monthly check. There have been endless discussions about this idea in wonkdom. Most involve the question of whether to give all the money back to the taxpayers. There are those who want to take some of the proceeds and use them to fund alternate energy sources. Miller takes a more direct free-enterprise route: he assumes that people will find ways to reduce their carbon usage and pocket (or spend) a nice chunk of their monthly dividend checks.

It probably doesn’t take much courage to propose an energy tax on the west side of Los Angeles (although the usual political route for Democrats is to acknowledge we have to do “something” about climate change and not get more complicated than that). In fact, Miller probably has opponents who want a more direct government hand when it comes to climate change–let the government, rather than the market, decide which new energy sources to support. (I should note that Miller’s idea has a quietly progressive aspect to it: poor people who don’t own cars, who–as Jesse Jackson once said–“take the early bus” would be getting the same monthly dividend as Hummer-drivers.)

The point is, Miller’s policies are not off-the-shelf, cookie-cutter plans selected by his policy staff. They are hand-made, fully realized. You may disagree with some of them. On some issues, like education, they fly in the face of your standard Democratic interest groups. But, having been through dozens of long policy discussions with Matt over the past 20 years, I can say this: his policies are what he actually believes.

TIME

American Legion Agrees: Shinseki Should Go

More than a year ago, I wrote a column calling for Retired 4-star General Eric Raymond Shinseki to step aside as Secretary of Veterans Affairs, given the utter mess in that department. James Koutz, the American Legion Commander at the time, led a round of criticism from traditional veterans groups:

“While we do not deny that problems and inefficiencies exist within VA and VA-related activities and programs, placing the blame on Secretary Shinseki is wholly unwarranted and disingenuous.”

Today, the Legion changed course:

“It’s a story of poor oversight and failed leadership,” said American Legion Cmdr. Daniel Dellinger, who also hailed the former Army chief of staff’s decorated military record. “This is the most difficult thing I’ve ever had to do.”

And it’s true, Shinseki is an extremely decent and admirable man with a heroic record of military service. But he hasn’t done very well adapting the VA to the information age or to the generation of troops returning home from Iraq and Afghanistan. The last straw for the Legion, apparently, was a report that 40 veterans had died waiting for doctor’s apointments while the VA’s Phoenix office lied about wait times–and even had a secret list of veterans waiting as much as 200 days.

It’s nice to have the Legion add to the pressure for genuine reform in VA. I thought they were being “disingenuous” last year. But–as I pointed out in the column–the problem doesn’t end with Shinseki. It extends to the top of the totem pole, to the White House where President Obama, who cares deeply about this generation of veterans–supporting their organizations and quietly visiting the wounded in hospital–just can’t seem to figure out how to reform a system that is a national embarrassment. One 4-star general told me that there are 2 VAs–an inner circle of excellent medical professionals who are devoted to their patients, surrounded by a vast mushy doughnut of public employees who have no incentive to work very hard. The stories of incompetence and insensitivity are endless. The VA may well be the worst bureaucracy in Washington.

True reform would require a tiny revolution. The President could ask the Congress to allow him a two-year experiment in lifting the civil service laws that make it practically impossible to fire those clogging the mushy doughnut. That’s a big fight, but a worthy one: There is no creative destruction in government, no accountability–and without accountability, efficiency is nearly impossible. And it might not be a bad thing if the President tried something to change the rather torpid and depressing conversation going on in Washington right now.

 

Correction: the initial version of this article didn’t include General Shinseki’s first name.

 

TIME

Jewish Organization Acts in an Un-Jewish Fashion

Over 5000 years of history, we Jews have demonstrated a remarkable talent for survival, the promulgation of morality and justice, tolerance of others, terrible cuisine and an almost protozoan genius for subdividing ourselves. Thus, there is an organization that is actually called the Conference of Presidents of Major Jewish American Organizations. It has 51 members, some of whom are not all that major–but ok, a diversity of voices, that’s good!

Except not this week. The Conference of Presidents Etc Etc…rejected the attempt of a liberal group called J Street to become a member. The vote was close, but despicable. Indeed, you might wonder what sort of barbarities did J Street commit to be denied entry? After all, there are antique socialist organizations like the Workman’s Circle in the COPOMJAO; there are organizations representing peaceniks, like Americans for Peace Now. J Street must be really extreme, right? Actually, no. It pretty much supports the Obama Administration line on a Middle East peace settlement and nuclear negotiations with Iran. Thereby, it represents a majority of American Jews, who voted for Obama in droves twice.

J Street does not, however, represent the views of AIPAC–the American Israel Public Affairs Committee–the heart of the so-called Israel Lobby. And AIPAC represents the views of Benjamin Netanyahu. It opposes United States foreign policy on the West Bank and the Iran negotiations–not always frontally, but reliably. COPOMJAO has traditionally followed a Likudnik line as well…and it appears that Jewish Neo-Conservatives have gotten a bit touchy about the possibility that a new group like J Street, which actually represents the views of a significant number of Jews, will grow into a real rival to the current out-of-touch Jewish establishment.

This is a decidedly un-Jewish development. Where I come from–the outer boroughs of New York City–Jews were known for, and entertained ourselves by, arguing about everything. Nothing was ever off the table. But I’ve noticed a tendency of the neo-conservative Jews to denigrate those who disagree with their extreme right-wing positions. They bully. They refuse to engage in a serious debate. They have a cult-like devotion to the party line. They call groups like J Street “anti-Israel,” when it’s possible, perhaps even probable, that COPOMJAO’s hard line will compromise Israel’s ability to thrive in the future.

The CPOMJAO rejection will work well for J Street. It will be “good” publicity, especially among those Jews who have been dismayed by those who claim to Judaism’s official leaders in America. COPOMJAO, meanwhile, seems as silly as its name. It needs reform, including a new identity: I would suggest The Jew Crew as a replacement, but that would imply a lack of self-righteousness and openness to diverse opinions that COPOMJAO doesn’t seem to have.

TIME

Sterling and Bundy Are a History Lesson in Racism

Correction appended, April 28

Here’s my favorite part of the Jeremiad that Los Angeles Clippers owner Donald Sterling allegedly unleashed upon his (former) girlfriend. He was speaking about his players:

I support them and give them food, and clothes, and cars, and houses. Who gives it to them? Does someone else give it to them?Do I know that I have—Who makes the game? Do I make the game, or do they make the game? Is there 30 owners, that created the league?

How utterly perfect. Not just in its crude paternalism, but also in its historicity: this is what Southerners imagined the reality of plantation life to be in the honeysuckle nostalgia that overcame the region after the abolition of slavery–and which the rest of the country, especially Hollywood, adopted until reality intervened in the 1960s. As the song goes, I wish I was in the land of Cotton/where old times are not forgotten.* Sterling’s statement was the rhetorical equivalent of finding a perfectly preserved 3000-year-old corpse in a glacier. It was a stinging blast from the past. Conveniently, it came in the same week that seditious rancher Cliven Bundy delivered his own discourse to the New York Times about things he “knew” about the “Negro”:

“They abort their young children, they put their young men in jail, because they never learned how to pick cotton. And I’ve often wondered, are they better off as slaves, picking cotton and having a family life and doing things, or are they better off under government subsidy? They didn’t get no more freedom. They got less freedom.”

Also perfect. This has been the traditional southern white working class lament since abolition: black folks are a threat to their economic and social status. In the 19th century, the former slaves “took” white jobs (because they worked cheap)–and later, in the 20th century welfare state: they got something for doing nothing. Taken together, Sterling and Bundy are a history lesson. They are confirmation of a ton of brilliantly written sociology about the culture of the South. Both men would fit easily into the archetypes limned by John Dollard in his classic, Caste and Class in a Southern Town–the plantation owner and the vicious overseer. Their rancid nostalgia was brilliantly described by C. Van Woodward in his essay, The Burden of Southern History and, especially in his book, The Strange Career of Jim Crow.

Cliven Bundy has an added vestigial overlay: He and his armed seditionists are as old as the Republic. Their libertarian Scots-Irish sensibility was described brilliantly by David Hackett Fischer in his history of colonial America, Albion’s Seed. They opposed federalism from the start: From 1791 to 1794, they staged the Whiskey Rebellion against the administration of George Washington, which wanted to tax the home brew they made from their excess crops. Washington himself had to lead a federal force (composed of state militias) to subdue the rebels, who disbanded quietly.

There are those who will argue: Well, of course. Nothing has changed. White folks are just getting scared, as their majority dwindles, and blurting out the things they always thought. There is, no doubt, some truth to that. America’s form of slavery was particularly brutal and has yet to be completely expunged from the psyches of either blacks or whites. (Dollard’s book, written in 1957, is particularly good on this).

But, as baldly loathsome as the Sterling and Bundy statements are, there is no question that this country has seen a sea change in race relations over the past half-century. You can walk along Main Street of any southern town during lunch hour and find blacks and whites sharing a meal, a joke, an embrace. You can watch any NBA playoff game and watch African-American players in a glorious variety of pigments, including a rising minority who are clearly biracial. Those trends will continue; there will be ugliness and misunderstanding as we inch along toward the ideal of a fully Mongrelized, and thereby strengthened, America. But they are unstoppable.

*Just listened to Bob Dylan’s version of “Dixie,” which manages to be both nostalgic and lacerating.

Correction: The original version of this story misstated the city in which the Clippers now reside.

TIME Medicare

The Return of Mediscare

In Arkansas, Democrats dust off an old tactic in order to retain control of the U.S. Senate

Tom Cotton is your basic republican red-state fantasy candidate. He is 36 years old, a former Army captain who served in both Iraq and Afghanistan, and a graduate of Harvard University and Harvard Law. He is a member of the House running for the U.S. Senate from Arkansas. His opponent is an unflashy Democratic moderate, Mark Pryor, who spent the first months of the campaign barraged by an estimated $2 million in Obamascare ads provided by Americans for Prosperity, the Koch brothers’ super PAC. Not surprisingly, Cotton has been leading–and is one of the reasons the Republicans may retake the Senate in 2014. Or maybe not: the polls suddenly turned around in March, and Pryor is now narrowly ahead. What happened?

Meet Linda … who joins Harry and Louise, and dozens of other average Americans–some real, some conjured–in the long, sordid history of political ads designed to scare the bejeezus out of other average Americans over health care. Linda appears to be real. She’s from Little Rock. She’s been married to the same lucky fellow for 37 years, and they have two “great” kids. We know this because a black-and-white family photo is shown prominently at the beginning of the ad. Then we see Linda, who seems to be in her 50s, with tightly curled gray hair and glasses, sitting in her breakfast nook gazing at her Apple computer. Retirement is just around the corner, she says. “That’s why I was so concerned when I read”–and here she seems to be reading off her computer–“that Tom Cotton voted to turn Medicare into a voucher system” that would allow insurance companies to “increase rates, cut benefits and cost seniors thousands more each year.”

It’s a brilliant ad, classic Mediscare. The fact that Linda seems to be reading the horrific news about Cotton off her computer lends a subtle authority to the information. Is it accurate? Well, yes and no. Cotton and 218 of his colleagues in the House did indeed vote for the Paul Ryan budget, which would slash costs by moving to a privatized “premium support”–or voucher–system of health care delivery for senior citizens. Is that a bad idea? Probably not. In fact, a more generous version already exists in the form of Medicare Advantage, the private-sector Medicare alternative that seems to be going great guns in the Obamacare era: an estimated 30% of seniors have signed up, an increase of 38% in recent years. The brute force of competition (plus some federal subsidies that both parties want to diminish) has allowed increased benefits like gym memberships and free medication. The fact that many of these plans are based within systems where doctors are paid salaries makes it potentially more cost-effective than classic fee-for-service Medicare. It would be very valuable to have a serious conversation about this. Pryor is a fiscal conservative. He’s said that all programs (including Medicare, presumably) should be on the table. He could be part of the solution, rather than hiding behind traditional Democratic battlements.

Democrats will say, Oh, come on. It’s about time we started playing hardball again. The Republicans strolled into a tornado by voting–symbolically, since it never had a chance of passage–for the Ryan budget. The Koch brothers have spent gazillions putting sketchy Obamascare ads on the air, including one starring Jerry, an Arkansas truck driver who “lost” his health coverage because of Obamacare, although maybe he didn’t, because the Arkansas insurance commissioner put a two-year delay on that ruling and now Jerry is “confused” by all these newfangled government machinations. This was one of the less toxic Koch ads–and “Jerry” has been smoked by “Linda” in the court of public opinion.

Of course, next month there could be a killer Obamascare ad starring “Arnie,” an Arkansas druggist whose health care premiums have skyrocketed. And later we may get to know “Marge,” who survived breast cancer because Obamacare saved her health insurance. We could go back and forth, Obamascare vs. Mediscare, all the way until November. It’s happened before. It’s worked before. But is it what you really want this election to be about? Isn’t it precisely the sort of campaign that turns people off politics? Don’t we have more important things to talk about? “I think the Republicans will still win the House and Senate,” says Steve Schmidt, a GOP consultant. “But when you have no real governing agenda, it becomes very easy to get caught up in entitlement issues.”

That is true for Democrats as well. They are proud of their demographics, especially the favor bestowed on them by younger voters. But younger voters may decide they don’t like paying for an unreformed Medicare system as we baby boomers live on and on and on. Those who live by the anecdote can die by the anecdote.

TIME Health Care

Obamacare Disaster!

I just love it when I see neoconservatives pushing story angles like this one:

a new study from Express Scripts, the large pharmacy benefits-managing company, reveals something else that ought to depress those liberals throwing victory parties for the success of the misnamed Affordable Care Act: those signing up for ObamaCare appear to be older, sicker, and more dependent on expensive, specialty drugs than the average person covered by employer-based health insurance.

Two points:

1. This study, no doubt accurate, comes from a pharmacy-benefits company. And yes, of course, Obamacare has signed up a lot of people with dire medical conditions who will be filing a lot of expensive prescriptions. That’s the point of the exercise. But this study says absolutely nothing about the number of young people who signed up–if they signed up–who don’t have expensive prescriptions to fill. That’s the point of universal coverage: the healthy young help pay for the unhealthy elderly. This is a moral and civic duty. The young and healthy someday will be old and less healthy. (We don’t yet have any reliable indications of how many young people showed up.)

2. What sort of twisted mind could believe that taking care of the “older, sicker and more dependent” on expensive drugs is not a good thing? I’ve never bought that all this would cost less–though real reform of fee-for-service medicine would certainly help some. I’m in favor of universal coverage as a communitarian proposition: it is a social responsibility that we have. In most cases, these are hardworking people–those who don’t work get healthcare through Medicaid. I’d rather see my taxes go to helping those who are suffering than to subsidizing hedge-fund traders who pay Romney taxes.

But I wonder about all those salivating over Obamacare failures, real or imagined: Do they ever consider the actual human beings involved, the sum of human suffering diminished–or are they just interested in the political calculus? (Don’t worry, folks: I think I know the answer.)

TIME politics

Why Obama Hit Pause

An Iran deal may be possible. Getting Israelis and Palestinians to make peace may not be

We know what a reasonable middle East peace would look like. In December 2000, Bill Clinton laid out the formula. There would be a return to the 1967 borders, with mutually agreed-upon land swaps so that the bulk–perhaps 80%–of Jewish settlements on Palestinian lands could become part of Israel. Jerusalem would be the capital of both countries. An international commission would control the religious sites in Jerusalem’s Old City. Palestinian refugees would have the right to return to Palestine but not to Israel. Israel’s sovereignty and security as a Jewish state would be accepted by the Arabs.

There have been other iterations of a framework agreement in the past 14 years, but they’re all based on Clinton’s plan, as Clinton’s was on previous plans. For those who actually want to see a Middle East peace negotiated, this is the consensus solution. In principle, it is favored by a majority of the Israeli and Palestinian publics and by the Saudis and the Arab League. In practice, who knows? The Israelis are always litigious about the details; the Palestinians always walk away at the last minute. But leading American strategists like Brent Scowcroft and Zbigniew Brzezinski have said the way to negotiate the impasse is for the U.S. to present an updated version of the framework and allow international pressure to push the Israelis and the Palestinians toward peace.

John Kerry seemed intent on doing that too. But his version of the framework has never been announced–and the chance of the two parties’ producing their own mutually agreed-upon outline evaporated long ago, if it ever existed in the first place. Kerry deserves credit for the energy he’s put into the process, but there has been a tinge of desperation to his efforts over the past months–a reminder of the wobbly garrulousness that has damaged President Obama’s foreign policy since he took office. Kerry raised the loathsome possibility of releasing Jonathan Pollard, a U.S. citizen who spied for Israel, in order to cajole the Israelis into continuing the talks. Then, in congressional testimony on April 8, he weirdly blamed the Israelis for the impasse because of their insistence on building 700 new apartments in an East Jerusalem neighborhood, Gilo, that everyone assumes will be part of Israel if the borders are redrawn. There has been, as with Syria last summer, a melted cheesiness to his public statements when the heat is on.

Why hasn’t Kerry published a framework for the talks as promised? In my interviews with current and former diplomats, a prevailing theme emerged: a reiteration of the Clinton framework would activate the Sheldon Adelson neoconservative wing of the Republican Party, plus many Christian evangelicals who see the annexation of the West Bank territories as biblical prophesy, and this is a fight that Obama doesn’t particularly want at this point. Why not? The President may want to keep his powder dry, in part to keep Jewish voters on the reservation in the 2014 midterms but also because another, more promising fight is looming with the neoconservatives–over the Iran nuclear talks.

Indeed, the Iran talks seem to be going as well as the Middle East talks are going poorly. That’s why you haven’t read much about them in recent weeks. There are still major issues to overcome, but Western negotiators have been impressed by the Iranians’ seriousness and unwillingness to use extraneous events–like the U.S.-Russian tiff over Ukraine–to try to delay the talks or split the U.N. alliance. It is not inconceivable that a deal limiting Iran’s ability to enrich uranium and a strict regimen of international inspections will be completed by the end of the year … although, once again, the Administration won’t want it to be finished until after the midterm elections.

The Middle East peace talks continue to chug along, at the request of the Israelis and Palestinians, even after Kerry declared them moribund. It turns out that neither side wants to abandon the illusion of progress–and Israeli Prime Minister Benjamin Netanyahu, in particular, may be keeping his powder dry for the Iran fight as well. But the paralyzed talks have now become another reminder of the Administration’s perceived weakness in foreign policy. Iran may well prove to be the President’s ultimate test–not just the political test of maneuvering a treaty through a Congress heavily influenced by the Israel lobby but also the diplomatic test of dealing with a complicated, opaque Iran, where the reactionary forces will want to reassert their authority if the treaty is successfully negotiated. A remarkable achievement may be within Obama’s grasp, but he and his Secretary of State are going to have to prove more solid, subtle and dependable policy implementers than they have in the past.

TO READ JOE’S BLOG POSTS, GO TO time.com/swampland

TIME politics

Obamacare: Mend it, Don’t End it

The Affordable Care Act has problems. But the GOP campaign to junk it is now finished

The endless, blindingly obtuse debate about the Affordable Care Act–also known as Obamacare–has been almost entirely about politics, not substance. There are two reasons for this. We haven’t had much real substance to go on. And politics is a lot easier for us wizards of the media to report and opine upon. The abysmal debut of the HealthCare.gov website is a lot easier to comprehend–government can’t tie its own shoelaces–than the heroic efforts to bring the site back to life. The people who “lost” their insurance because of new coverage requirements are more famous than those who were able to get better, cheaper coverage through the new government health care markets. (Actually, they’re many of the same people.) The fact that 7.1 million people signed up for insurance is more important than who they actually are: Were they uninsured in the past? Will they pay their bills? Will they get the care they’re paying for? Will the system be able to handle all the new traffic?

But we have now turned a corner. the system is up and running. It has 7.1 million customers (plus 4.5 million more in the expanded Medicaid program). The word of mouth seems to be … not bad: a recent ABC News–Washington Post poll actually had more Americans in favor of Obamacare than opposed to it, by an overpowering 49% to 48%. Those numbers may well improve over time as the public learns that the program isn’t the socialist cataclysm that Republicans predicted. It may even happen by November. It is not impossible that Americans will be pleased that a significant social injustice has been rectified: the hardworking poor finally have health care protection, just as the indigent on Medicaid have had. Indeed, there is one political thing that we know for sure: the Republicans have lost this debate substantively. The law won’t be repealed. “There is no off switch,” says Professor John DiIulio of the University of Pennsylvania, who is studying the system from the bottom up in 35 states. “There are financial obligations to the people who have signed up [and receive subsidies from the government]. There are 50 different stories here. The program is different in every state. That makes it difficult to formulate a national policy response,” whether it be repeal or sweeping reform.

Which doesn’t mean the Affordable Care Act doesn’t need reform. It is a slovenly piece of legislation that will need constant modification and in some cases structural overhaul. The very notion that there are 50 stories here demonstrates a glaring inefficiency. There should be four or five regional exchanges–they should be supermarkets, not corner stores, providing greater economies of scale. There ought to be (as six moderate Democratic Senators proposed) a wider variety of insurance options, including plans with lower premiums and higher deductibles. There should be fewer mandated coverages: if the Jones family believes it receives all the mental-health counseling it needs through its church, it shouldn’t be required to pay for mental-health coverage. Businesses that currently provide health coverage for their employees in the private market, especially moderate-size companies, should be free to shop for better deals in the health care exchanges. The President has been open to negotiation on most of the above, as well as conservative evergreens like medical-malpractice reform.

A recent Kaiser family foundation poll shows that 59% of Americans want to see this program improved, not repealed–another reason the Republicans have lost this debate. There are legitimate arguments against government expansion, but the Republicans haven’t been making them. Instead they’ve resorted to fear tactics (remember “death panels”), demagoguery (socialism!), concocted bad-news stories and irrelevant bean-counting. One reason the 7.1 million people signing up became such a big deal is that Republicans made it a litmus test. Given public disgust with the noxious atmosphere in Washington, you might expect that the GOP would be ripe for a reset on this issue. They could argue, We’re gonna reform this thing, make it an efficient free-enterprise model for the world. After all, the bone structure of Obamacare–the exchanges, the individual mandate–came out of the conservative Heritage Foundation 25 years ago.

But no. John Boehner and other GOP leaders sent a reflexive message to the 7.1 million enrollees: they’re still against it, no retreat, no surrender. That makes political sense in a dull, conventional-wisdom way. Current polls have them winning the House and perhaps the Senate in November. But what happens if Obamacare brings better coverage to millions of Americans between now and then? What happens if the good-news stories start outplaying the bad? Politics is never static, especially seven months from Election Day.

TO READ JOE’S BLOG POSTS, GO TO time.com/swampland

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