Hillary Clinton the Maverick?

Yesterday, the Kaiser Foundation released its first poll on health care reform and the 2008 presidential election. The group plans to track the poll throughout the campaign.

Most of the results aren't that surprising. Health care is listed as the second most important issue to Americans of all political stripes behind Iraq, as just about every poll on the topic has shown.

But one point that did jump out was when the survey asked about the presidential candidates and health care reform.

One of the questions was, "And...thinking about all of the candidates for president, regardless of political party and whether or not you agree with their views, which candidate do you think is placing the BIGGEST EMPHASIS on health care issues?"

Far and away the response given the most was Hillary Clinton. 28 percent of Dems, 20 percent of independents, and 19 percent of Republicans named her. The next on the list was Barack Obama for Dems (10 percent) and independents (5 percent), while John Edwards and Rudy Giuliani tied for second among Republicans (3 percent).

Hillary Clinton? Putting the BIGGEST EMPHASIS on health care issues? Really?

Maybe in 1993-1994, but since then Clinton has been quite reluctant to utter the word "reform" alongside health care in any meaningful context.

Oddly enough, this suggests that the special interest thrashing Clinton took over a decade ago when she tried to spearhead national health care reform could actually help her 2008 presidential bid. That incident not only scared Clinton away from the topic, it kept just about every politician on the national stage from pushing fundamental reform for over a decade.

So, it seems, now that fundamental health care reform is back in vogue, the name that many people still associate with trying to do something significant about the health care crisis -- even though she failed -- is Hillary Clinton.

In that sense, if she plays her hand right, health care reform could be Clinton's maverick card. She was on the front lines fighting for it before it was politically cool.

And for those who think Clinton is too stiff to strike a populist chord, check out this new TNR piece on how she won over steelworkers, ironworkers, construction workers, and the whole bunch at a recent union rally, in much the same way that she won over farmers in upstate New York during her senate runs.

Another interesting point of the poll is that in spite of the fact that nearly 1 out of every 3 Republican respondents listed health care as the most important problem for government to address -- even ahead of Iraq -- when asked who best represents their views on health care reform, the GOP candidate mentioned most was Giuliani at just 7 percent.

Guess who else was named 7 percent of the time by Republicans: Hillary Clinton.

Can you say wedge issue?

What Private Insurers in Wisconsin Want

An umbrella group for four associations that represent health insurers and underwriters in Wisconsin released a report yesterday outlining the characteristics of "sensible" health care reform in the state.

The group -- named the Coalition for Sensible Health Care Solutions -- listed these six requirements for reform:

• It must ensure that all Wisconsinites have access to basic health care coverage.
• It must neither bankrupt families nor the state.
• It must provide the state’s diverse population with equally diverse health care coverage choices.
• It must promote ongoing and long-term innovation that adapts to the evolving needs of our citizens.
• It must address and reduce skyrocketing medical care costs.
• It must provide consumers access to meaningful information and expert advice from licensed insurance professionals.

Let's take each point one-by-one.

It must ensure that all Wisconsinites have access to basic health care coverage.

This one is a bit of a no-brainer. But one key piece that's missing is the type of health coverage that Wisconsinites should be able to access. The word "basic" is used, but that doesn't tell a whole lot. As a number of recent studies have shown (see here and here for two examples), the under-insured are as significant of a problem as the un-insured.

It must neither bankrupt families nor the state.

This is certainly an important point to take into account. But considering our current system is bankrupting many families and the state, in many ways doing nothing -- or just tinkering around the edges -- is actually the most costly approach.

It must provide the state’s diverse population with equally diverse health care coverage choices.

This is the tricky one. As I discussed earlier in the week, risk pooling is an essential facet of any successful and affordable health coverage system. However, the preferred business model of private insurers in the current system involves targeting the least risky (and, hence, most profitable) participants, not pooling them in with those who have expensive or frequent claims.

The way I read this requirement is that insurers want the flexibility to continue the profit driven practice of adverse selection. I certainly don't have a problem with businesses seeking a profit, but the insurance industry needs to recognize that there are more significant moral implications in pricing someone out of health coverage than there are with pricing them out of other private markets.

Nevertheless, it's certainly agreed that any reform involving private insurers needs to allow some room for insurance companies to make a profit...it just shouldn't come by practices that marginalize or exclude those who need affordable health care.

It must promote ongoing and long-term innovation that adapts to the evolving needs of our citizens.

Innovation of insurance products? I can understand the need for some excess money on the provider side to spur medical care innovations and investment in better technologies, but I'm not so sure about that same need on the payer side.

However, any reform proposal that uses private insurers -- for instance, the Wisconsin Health Plan -- would encourage innovation by putting insurers into competition with each other for participants. And as long as more innovation = more efficiency = more profits, there should be innovation aplenty in the system.

It must address and reduce skyrocketing medical care costs.

Interesting how this one puts the emphasis on medical care costs, as if that's something that can be separated from skyrocketing health care costs as a whole. The difference, of course, is that the latter includes those costs associated with the payer side, too.

Other than that, this point seems pretty identical to the second point about not bankrupting families or the state.

It must provide consumers access to meaningful information and expert advice from licensed insurance professionals.

This one just screams, "No single payer -- let us keep our jobs!" Fair enough. If I worked in the private health insurance industry, I'd be screaming the same thing. While there are undoubtedly moral implications to no reform, there are also moral implications to reform that essentially wipes out an entire industry in one swoop.

But that doesn't mean things can't or shouldn't change. And, in the long run, change that brings stability to the health care system as a whole will benefit private insurers.

At the very least, they won't need to keep justifying their own existence.

Pay It Now or Pay More Later

It seems like whenever I write about the need for universal health care coverage, a commenter will add a legitimate gripe about the problems with mandating health coverage.

If someone doesn't want it, why should she or he be forced to have it? An answer to that can be found in a LA Times article that appears today.

It's been well documented how some insurance companies -- if state law doesn't preclude it -- will find a way to cancel an individual health policy if that policy starts to get too expensive. In fact, in California, the state's largest insurer, Blue Cross Blue Shield, was recently fined $1 million for unjustifiably canceling the policies held by the chronically ill and those who were pregnant.

Apparently Blue Cross had an entire department dedicated to searching out expensive policies that it could manufacture some loophole -- for instance, claiming applications for coverage were incorrectly filled out -- to justify ending. State regulators in California are in the process of investigating other insurers for similar practices.

But what the LA Times article from today highlights is the somewhat more recent trend of group policies for the self-employed -- often offered through trade associations -- being canceled due to their growing cost.

This is how it happens. The healthier -- often the young -- are encouraged not to participate in the association health plan and instead either get cheaper bare bones coverage on their own in the individual policy market or opt for no coverage at all.

That leaves the less healthy and unhealthy -- often older people and families -- in the association health plan. But since the healthy are no longer there to disburse the risk, the policy costs skyrocket to the point that it becomes unaffordable for the participants and/or not profitable enough for the insurer.

And once on the individual policy market, the less healthy face an uphill battle in getting coverage that could be considered affordable, while the unhealthy have virtually no shot at all.

Targeting the healthy is a conscious trend in the insurance market across the country that mirrors the conscious trend by payers to cater to those who have insurance. And at the crux of those trends is the core of the growing American health care crisis.

A recent Journal Sentinel article highlighted a similar trend taking place here in Wisconsin. As older, and thereby more risky to insure, people have found themselves booted from group coverage, they discovered how much the individual policy market isn't designed for them these days.

This is one of the major problems with the Bush health care tax proposal (I discuss the other in the update of this post). By instituting a $15,000 standard deduction, it encourages the healthy to either get a cheap bare bones policy or leave the insurance market altogether and net the entire value of the deduction. This, of course, works to centralize the risks and the costs on the less healthy and unhealthy who are left in the insurance market.

The only way to keep policy costs down is to disburse the risk amongst the healthy, less healthy, and unhealthy. And the more you group these populations together, the more the risk is disbursed and the flatter the costs become.

And while it may not seem right to some observers that healthy individuals are forced into plans for the purpose of disbursing risk and flattening costs, the fact is it's worse to let a growing segment of the less healthy and unhealthy population languish without access to affordable health care.

What's more, while a cheap bare bones policy or no policy at all may seem advantageous to the healthy while they're, well, healthy, the reality is that the vast majority of the population will not always be healthy (or have dependents who are always healthy).

By participating in the system while they're healthy, they're ensuring that they'll be able to continue participating in an affordable system when they or one of their dependents are not so healthy.

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Side-Note: I should add that it seems reasonable to allow for a religious waiver for those whose beliefs are not in line with the use of modern medicine. Of course, it's assumed that these people wouldn't want to participate whether they were healthy, less healthy, or unhealthy.

Also, for those concerned that the healthy will be helping those who are less healthy and unhealthy because the latter two groups didn't take care of themselves, there are ways to implement a universal system that uses risk pooling and has significant financial incentives for staying as healthy as possible.

The Wisconsin Health Plan, for instance, is designed in a way that pools everyone together in the same private health plans, but the out-of-pocket costs that are incurred after a certain amount of coverage ($500 for adults) would encourage healthy behaviors.

The out-of-pocket annual maximum for families would be $3000 -- or $250 per month -- which is enough to encourage people to be as healthy as possible without making care unaffordable for those who need it (state assistance would be available for the poor).

Clifford's Supporters Oppose School Choice?

SEE UPDATES BELOW

I was caught by a comment made in the Journal Sentinel this morning regarding the state Supreme Court race.

While the article in question claims it's unclear where either Linda Clifford or Annette Ziegler stand on the school voucher program, it states that a few things are clear, including the following: "Clifford's backers include many people and groups who oppose the school choice program. Ziegler's backers include many who favor the program."

Hmm. I remember following the school voucher debate pretty closely last January. And though it's been awhile, I only remember two groups -- WEAC and the Milwaukee Teachers’ Education Association (MTEA) -- that opposed the voucher program.

While GOPers tried really hard to make the voucher debate a "for or against" issue on the program as a whole, the debate was really over how much the program would be expanded. Governor Doyle and most legislative Dems backed controlled growth along with instituting classroom accountability and many legislative Republicans supported removing the cap altogether without classroom accountability.

Looking at the list of supporters on Clifford's website along with the list of her campaign donors, I don't see WEAC or MTEA. And I couldn't find anything on either group's website about Linda Clifford or the state Supreme Court race in general.

It seems to me this JS article was making an assumption -- and, perhaps, an inaccurate one -- based upon the fact that Clifford is essentially the Dem candidate and Ziegler is essentially the GOP candidate. So you could really substitute any partisan issue with clear consitutional implications into that statement.

For instance, "Clifford's backers include many people and groups who support a woman's right to choose. Ziegler's backers include many who oppose a woman's right to choose."

Or, "Clifford's backers include many people and groups who oppose concealed carry. Ziegler's backers include many who favor concealed carry."

But, of course, the tricky part about using school vouchers is that neither party has proposed eliminating the voucher program; again, the debate was (and is) over the program's growth.

And, ultimately, all of statements listed above say very little about what either candidate would do as a state Supreme Court justice to impact any of the issues at hand. Although the JS article said its version of the statement was "clear," rather than providing clarity, it actually did nothing more than increase speculation, just as any version of that statement would.

Nevertheless, I emailed Alan Borsuk -- the lead author of the JS article -- this morning to see what he was basing the statement upon. I'll add an update when I hear back.

UPDATE: Borsuk responded by giving WEAC and the Milwaukee County Labor Council (MCLC) as two examples of voucher opponents who have endorsed Clifford.

Jay also notes in the comments that WEAC has endorsed Clifford, but I still can't seem to find the endorsement. It's not on WEAC's webstite or Clifford's website, and there's no listing of it at the Wheeler Report or WisPolitics dating back through the time that Clifford announced her candidacy at the beginning of January. And, as of February 5, WEAC had not given any money to the Clifford campaign. Perhaps it was just noted in a newsletter or memo sent only to teachers?

It doesn't appear the MCLC has formally endorsed Clifford, although its sister organization -- the Wisconsin AFL-CIO -- has done so and donated $5000 to Clifford's campaign. The MCLC, for its part, does have a couple of pieces on its website that go after Ziegler, which certainly could be construed as an implicit endorsement of Clifford.

However, that said, I couldn't find anything about the MCLC -- or, for that matter, the WI AFL-CIO -- being a vocal opponent of the school voucher program, let alone advocating for its elimination.

And, in the end, I still haven't seen any evidence that gets close to buttressing the argument that "Clifford's backers include many people and groups who oppose the school choice program." It seems, at the most, that the vast majority of Clifford's backers actually don't have a public position on the program at all.

LATE UPDATE: I just heard from another person that WEAC has recently endorsed Clifford and donated to her campaign. Whether this alone means "many people and groups" remains in question.

LATE LATE UPDATE: The latest campaign finance figures are out, and it appears I'm caught a bit with my foot in my mouth. If I would've seen this morning that WEAC subsidiaries have shelled out around $35,000 to Clifford's campaign in the last couple of weeks, I definitely would have kept my trap shut about the JS article line.

Although I still don't think the line is entirely fair or accurate -- the vast majority of Clifford's supporters are still not active voucher opponents -- the line got a whole lot more justifiable with the WEAC donations.

This is why I should stick to policy.

Want to Know How Much I Make?

All you need to do is visit this site on any UW System computer, request a disk with the info from any UW campus, or call the UW-Milwaukee HR Department at 414-229-4463.

Evidently for some legislative Republicans, that amounts to keeping it a secret.

Since no other public employee salary information at any level in Wisconsin is that accessible, it seems to me GOPers like Suder are just about taking any opportunity they can get to publicly throw some crap -- even an eye-rolling amount -- at the UW System.

The (In)Efficiency of Private Medicare Plans

A recent congressional inquiry has shed some light on findings by the Medicare Payment Advisory Commission (MedPAC) that private plans associated with Medicare -- known as Medicare Advantage -- cost the federal government between 10 and 19 percent more than traditional coverage in the public plan.

If the private plans were eliminated, estimates are that it would save the public coffers $65 billion between 2008 and 2012 alone.

Of course, this brings into question the long held belief of many conservatives that the private sector can always do everything more efficiently and, as a result, cheaper than the public sector.

But what makes this a case -- at least on the surface -- for bizarro world is how the political lines are forming around it.

The congressional inquiry has sparked at least one Democratic lawmaker -- Rep. Pete Stark (D-CA) -- to charge that the extra cost is too much, while more than one Republican lawmaker has come to the defense of paying more for Medicare Advantage because the private plans in it tend to offer more coverage for those seniors who may need it.

Huh? Dems talking about cutting public spending on social services, and GOPers countering that we need to continue spending more tax dollars to help those in need?

Well, not exactly those in need...unless you consider private insurers who generate, on average, about 30 percent of their total revenue from participating in Medicare Advantage to be in need.

To explain, it is true that Medicare Advantage plans typically provide more coverage than the traditional Medicare plan. But it isn't true that in all cases that extra coverage can explain why Medicare Advantage plans cost more.

According to MedPAC in its testimony before Congress on Wednesday, private insurers initially make a bid on the same coverage offered by the traditional Medicare plan and then are paid "rebates" on top of that for the extra coverage they provide.

The average bid for private HMO plans is 97 percent of the traditional Medicare plan cost -- which makes sense because HMOs have limited provider networks while the traditional plan doesn't -- but that's the only type of Medicare Advantage plan this is cheaper than the traditional plan.

The average local PPO bid comes in at 108 percent, the average regional PPO bid at 103 percent, and the average private fee-for-service bid is 109 percent of the traditional Medicare plan (which is also fee-for-service).

(Side-Note: You can get an explanation of HMO plans here, PPO plans here, and fee-for-service plans here.)

So that means the traditional Medicare plan is 3 percent more efficient than the average private regional PPO, 8 percent more efficient than the average local PPO, and 9 percent more efficient than its private counterpart fee-for-service plan.

The recommendations of MedPAC are to keep Medicare Advantage but just scale back the initial bid levels of the PPOs and fee-for-service plans so that they match or come in under the traditional Medicare plan. This seems reasonable, especially if it maintains the ability of seniors -- which most seem to want -- to have some amount of choice over their health plan.

It'll be interesting to see whether the GOP lawmakers back this sensible recommendation, or if they insist on spending more public revenue on private industry in spite of the latter's inability to be what it always said it would be: more efficient.

Where All the Bloggers At?

I definitely owe a debt of gratitude to the folks at WisPolitics for helping to get my blog some readership. Mine is probably the least-read blog on the WisOpinion "Featured Blogs" list, and my readership has gone even further south since I made a conscious turn toward blogging on policy issues after the November elections.

Here's my monthly SiteMeter count to demonstrate the unmistakable trend:

That jump last spring corresponds with when I was added as one of the "Featured Blogs" on WisOpinion, along with when my posts started to appear on the "Editorial Links" section on a more regular basis. And the relatively small readership I have managed to retain in recent months, I'm sure, is very much due to the continuation of this blog's place on WisOpinion (including they're posting of this very piece).

That said, in spite of all the help WisPolitics has provided me and, surely, many other small-timers in the political blogging community -- who make up the majority of political blogosphere -- I have to question whether the 2nd Annual WisPolitics Blog Summit is really about those same bloggers.

Of course, there is some legitimate debate over who's actually part of "the blogging community" and who isn't. And the lines that define that community, in many cases, are really quite blurry.

But I do think a difference can be drawn between those whose sole (or primary) avenue into the state political discourse is their blog and those who use their blog as more of a supplement to their engagement in state-level politics.

The blur comes in when you consider those whose blog was the main catalyst in catapulting their voice into more traditional media formats like TV, radio, and print, or their influence into areas such as political consulting or high level campaign work (I should add that not every blogger wants to be catapulted).

But, for the most part, a pretty clear divide could be found from asking the simple question: If blogging was outlawed tomorrow, whose voice or influence would be left?

And looking at the list of people chosen to speak at the 2nd WisPolitics Blog Summit, I see only one that probably wouldn't (although I'm sure Jay would continue to have strong local influence, particularly in MPS matters, and he's easily smart enough to get himself a prominent place in state politics without his blog if he wanted).

This is not to say that the summit won't be a beneficial event for bloggers of all shapes and sizes. The panel topics all look interesting and pertinent. Nevertheless, the main discussions that take place on all of them except the last are going to have the distinct perspective of those who really don't need their blogs to have a seat at the table.

It will be interesting to see how the effect of this plays out.

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Side-Note: I want to add that the title isn't meant to imply that the participants in the summit aren't really bloggers. As I note in the post, that's a complicated and subjective question. And, in the end, the complete definition of "blogger" is surely broad enough to encompass anyone who, well, takes the time to blog.

Instead, the title comes from my favorite line from the movie Blazing Saddles, which just happened to pop in my head after I read through the summit line-up. Here it is:

Lying and Lying Boldly

The Cap Times printed an AP story yesterday on the 2005 federal legislation, which is set to go into effect this week, to extend the allowable length of trucks from 75 to 97 feet.

Plain old logic would tell most people that this move wasn't done with safety in mind. Money, of course, is the true culprit: bigger profits for the trucking companies and bigger campaign donations for the politicians.

But here's the section of the article on Rep. Jim Oberstar's (D-Minn) decision to back the legislation in his role as ranking member of the House Transportation Committee:

A spokesman for Oberstar, who is now chairman of the House Transportation Committee, said that the congressman supported the amendment after looking into it and determining the new rules would be safe.

"Jim has traditionally been concerned about longer vehicles," said the spokesman, John Schadl. "He took a long look at this and had to be reassured before he would allow it."

So Oberstar looked into it before voting and determined that safety wouldn't be harmed by allowing trucks one-third the size of a football field on the road in spite of the fact that his initial reaction told him otherwise. *I'd say* that's a lie.

Now observe the section of the article on Rep. Paul Ryan's (R-Janesville) decision to back the legislation:

[Ryan] said that he and several colleagues decided to write the letter to the committee in 2005 because they believed the change would be good public policy. Ryan argued that it will improve safety and reduce fuel consumption.

So not only would the legislation not harm safety, Ryan claimed that increasing the length of trucks by 30 percent would improve safety on the roads. *I'd say* that, my friends, is a bold lie.

Come on, Oberstar. You gotta own your deceit if you want to roll with the big boys.

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UPDATE: See the comments for an explanation of the *I'd say* additions.

Comparing Federal Health Plans: Who Wins?

I haven't given much thought to health plans proposed at the federal level. Consensus is difficult enough to reach at the state or local level, it seems believing an agreement can be reached at the national level any time soon requires a leap of both faith and logic.

And by the time something does move forward in Congress and make it to the president's desk, the proposals that are currently before our federal government will be little more than a distant memory, anyway.

But a new analysis by the independent Commonwealth Fund of four major national reform proposals is still interesting because it provides a quick, yet thorough, glimpse into what federal reform would do and what it would cost.

The four main plans investigated were:

1. The Health Care Tax Reform Proposal (President Bush)
   
2. The Healthy Americans Act (Sen. Wyden)
   
3. Federal/State Partnerships Bill (Rep. Baldwin and others)
4. AmeriCare (Rep. Stark, Sen. Kennedy, and others)

Here's a handy chart that breaks down the coverage and costs involved in all four:

Putting the Federal/State Partnerships Bill up against the others probably wasn't the best thing to do since it's a proposal that depends almost entirely on state proposals that have yet to be defined.

But it's clear the other three plans, according to the Commonwealth Fund review (which was actually completed by the Lewin Group), would all decrease overall health system spending while increasing the number of insured.

Of course, the term "insured" doesn't always mean the same thing. Although the Healthy Americans Act and AmeriCare seek to extend comprehensive insurance, as the Commonwealth Fund report explains (emphasis mine), "The president’s proposal achieves savings by reducing the comprehensiveness of coverage and inducing lower utilization of services."

You can read more about that in the update of this post.

But one of the more eye-opening sections of the Commonwealth Fund report is where it breaks down the savings under each of the proposals for individuals/families based on income level.

Here's the chart for the Senator Wyden's Healthy Americans Act:

Here's the chart for the Rep. Stark's AmeriCare plan:

Here's the chart for President Bush's Tax Reform Proposal:

The trends there are unmistakable. And they're also consciously crafted by the sponsors of each proposal.

And don't forget the Healthy Americans Act and AmeriCare proposals would insure roughly five times the number of people as the Bush tax plan, and do so using comprehensive insurance rather than scaled down coverage.

These proposals aren't going anywhere, at least in the near future, but it is useful to look at where each puts its priorities for health care reform.

UPDATE: I should add that the Commonwealth Fund report is mostly a short term analysis. Long term prospects for each plan discussed are likely to be different.

The big long term problem I have with the Bush plan is that it provides incentives for the healthy to leave the insurance market. By doing so it concentrates the market risk on those less healthy individuals/families who remain, subsequently concentrating the cost on them. And the manner in which the tax deduction is indexed, over time a larger portion of people who remain in the insurance market -- i.e., the less healthy -- will see their taxes increase as annual premiums surpass the deduction cap.

As for AmeriCare, the short term savings come from reduced administrative costs associated with a single payer system. Whether these savings can be sustained over time by providing incentives for people -- and providers -- not to over-indulge in their comprehensive coverage is a big question.

It's my belief that the Wyden plan offers the most promise for short term and long term sustainability because it provides incentives for both remaining in the insurance market and being at least somewhat conscious of the health care choices that are made. How conscious, of course, is key to making sure spending is controlled into the forseeable future.

In a roundabout way, looking at the short term and long term propects of these federal plans really sheds light on the promise of the Wisconsin Health Plan. Not only does the WHP cover everyone and make sure the healthy remain in the market for risk pooling purposes, it also provides unquestionably strong financial incentives for people to be conscious of their health care spending without risking their health by encouraging them to bypass on preventative or emergency care.

Coming Around to the WHP

When I initially looked at the Wisconsin Health Plan (WHP) almost a year ago, I saw it as a legitimate attempt at solving the growing health care crisis, but one that simultaneously was based on a flawed structure that relied too heavily on market forces to control costs.

Even then, however, the way the plan wisely blended liberal equity with conservative individuality was clearly a feature that made the WHP the most politically tenable of the three major health care reform proposals to date (here and here are the other two).

More recently, though, I have started to see the merits of the WHP beyond just political expediency. Two recent additions to the Health Care Reading list (in the right-hand column, just under the Lefty Blogs feed) have helped with this.

The first is a report by the American Association of Pediatrics (AAP), which provides an excellent overview of the current structure and use of High Deductible Health Plans (HDHPs) in the US. Most eye-opening are the sections on the funding of individual medical savings accounts associated with HDHPs and the application of the deductible to preventative care.

According to figures cited by the AAP, only 20 percent of HDHPs in the US currently have employer-funded HSAs or HRAs associated with them. That means the other 80 percent rely entirely on the patients to fund the full annual deductible that can range from $2,000 to $10,000 for family plans. Not surprisingly, this set-up has contributed to a rise in unpaid medical bills in the Milwaukee area and elsewhere, which hospital execs directly attributed to high deductibles in a recent Journal Sentinel article.

Also noted in the AAP report is the fact that, as written in federal law, HDHPs can be structured so that preventative care is not applied to the deductible. The benefits of this set-up are clear in that it provides incentives for patients to get the routine care that can catch medical problems early before they develop into more complicated and costly ailments.

Unfortunately, though, the AAP reports that only 30 percent of HDHPs currently provide preventative care separate from the deductible. The other 70 percent force people to pay out-of-pocket for routine care until the entire deductible is met.

Of course, poor funding for individual medical savings accounts and applying preventative care to the high deductible is not the way HDHPs need to be set-up; it's just the way they are being set-up in our existing fragmented health system.

This is too bad since the use of HDHPs does provide some promise. For instance, a study by the Harvard Medical School recently found that HDHPs reduced the number of ER visits for non-critical ailments by 10 percent. And non-critical repeat visits to the ER dropped by 25 percent under HDHPs. Visits for critical ailments were not significantly affected.

Since ER overcrowding is a big problem, particularly for urban hospitals, cutting down on ER visits that really aren't emergencies -- such as those for headaches, nausea, or colds -- is a promisng trend.

But right now the promise of HDHPs is being severely dampened by the way they are being rolled out without necessary financial protections for patients such as even partially-funded individual medical savings accounts or preventative care that isn't applied to the deductible.

The beauty of a plan like the WHP is that it provides those financial protections that patients need -- in the form of a minimum HSA contribution of $500 and fully covered preventative care -- while also allowing and encouraging those patients to be consumers.

Of course, by charting out a middle ground, the WHP risks being attacked by some on the left because it isn't single payer and by some on the right because it involves government regulation of the health care market.

Hopefully enough people on both sides actually read through the plan and see that it is possible -- and quite desirable -- to have the best of both worlds.

Hoops Time

This morning is the first time I read the news since Sunday; yet, in all of the stories I gleaned, I still couldn't seem to find anything of political substance to write about.

The big news, of course, is the March Madness that kicks off today.

March Madness is always big this time of year, but it seems even bigger this year. From stories on employers letting employees off-the-hook for a bit of hoops time to reports that hoops time will cause Internet slowdowns to legislative proposals to legalize betting on hoops time.

I'm in one tourney pool with some friends from high school. I've got Florida, Pittsburgh, Georgetown, and Ohio State in the Final Four with Georgetown taking it over Florida in the final. I have Wisconsin bowing out in the Sweet Sixteen and Marquette losing today.

Don't ask me why I made those picks. I haven't watched or more than glanced at any reports on a college basketball game all season (I prefer football and Brewers baseball), so my friends should feel really bad if I'm able to actually beat them.

But that's what makes hoops time and the tourney so much fun -- anything can happen. That's, unfortunately, a risk that the college football power brokers have been unwilling to take.

Feel free to tell me why my picks are wrong in the comments.

Away for a Few Days

I'm going to be away from the blog for a few days for some fun and excitement at a higher education conference in (hopefully) sunny Orlando.

The highlight of the conference is surely going to be Tuesday night when Hootie & the Blowfish is scheduled to wow the crowd of higher education users of Oracle applications.

What a long, strange trip it's been for Hootie since the heady days of the mid-90s.

I should be back to the blog on Thursday or Friday.

The Bush Effect: A GOP Presidential Pickle

George W. Bush has really done a number on the early 2008 presidential race for the GOP. And most of the trouble centers on the Iraq War.

Rudy Giuliani seems to have the most steam, at this point, probably because he more than any other GOPer in the country can bring people back to the post-September 11th days when unadulterated resolve and bravado were just what the doctor ordered.

But by heading into Iraq less than two years later -- without much or any consideration for how to get out -- Bush has transformed pure resolve and bravado from useful national security characteristics to perceived national security risks.

For instance, the president's "bring it on" comment brought some scorn in 2003; however, much of the country was still with him on it at the time. But could you imagine the public reaction if he or anyone else uttered those words or anything like them now?

John McCain undoubtedly has been caught with his pants down during this transformation more than any of the other GOP presidential contenders. As Ezra Klein summed it up yesterday:

The tragicomic part, for McCain, is that in 2003, he was the perfect candidate for...2008. But he spent the intervening years sucking up to Bush and cozying up to the establishment and making nice with Jerry Falwell and generally debasing himself to coalesce the Republican Party around him, only to find, for the first time in memory, that that may have been a sucker's game. It's possible that, when all is said and done, not only will he have humiliated himself only to lose, but he'll have lost because he humiliated himself. It's downright Shakespearean.

(Matt Yglesias also offers a good synopsis of McCain's strategic follies here.)

But probably the most interesting aspect in all of this is how the Bush presidency has fundamentally changed what it means to be a conservative, at least for those wishing to take over the reins of the White House in 2008.

A case in point is Nebraska Senator Chuck Hagel, who -- rumor has it -- is getting set to announce a presidential bid early next week. Hagel is a conservative in the traditional Goldwater sense of the word.

The well-respected National Journal, in fact, recently gave Hagel one of the highest conservative rankings in the US Senate. Hagel's conservativism clearly outpaced McCain's in the rankings, 72 to 56.7, and it even edged out Sam Brownback's score of 70.3 percent. And if Giuliani or Mitt Romney were included in the rankings, I bet Hagel's conservative credentials would put their's to shame, too.

And -- importantly for any national candidate these days -- on the issue of foreign policy, there are few GOPers who are more knowledgeable or respected than Hagel. While Giuliani played a foreign policy guru on TV from his municipal level post after September 11th, Hagel has actually been in a role where foreign policy is one of the explicit job duties.

It's true, of course, that whether someone is actually strong on foreign policy isn't as important as if they appear to be strong on foreign policy, which is why Giuliani's TV image is probably more important than Hagel's actual experience. But it's also true that the conservative media machine is powerful enough to easily make Hagel a household foreign policy name and the darling of "security moms" across the nation if that's what it wanted to do.

But it's clear that's not what the conservative media machine wants to do, and there's one obvious reason for it: Hagel's vocal criticism of the way Bush has handled the Iraq War.

So, essentially, what Bush has done is effectively marginalize the most conservative presidential candidate in the race. And, just to twist the knife a little more, it's happened over an issue that it's blatantly obvious to the vast majority of Americans that Hagel was right about and Bush was wrong about.

If I was a Republican, I'd rank that right up there with runaway spending as the most treasonous acts Bush has committed in regards to conservative doctrine.

But, interestingly, it looks like Hagel may hold the cards necessary to have the last laugh on this one. As Chris Cillizza notes in today's Washington Post, a bipartisan group calling itself "Unity 08" has been working hard to develop the political infrastructure for a viable third party candidate in 2008. If Hagel enters the race and doesn't win the GOP nom, he could become a frontrunner for that third party run.

And unlike Pat Buchanan, who was hardly a blip on the Republican radar in previous presidential races, Hagel has the ability to take a big chunk out of the GOP vote on election day.

UPDATE: The Hill is reporting this morning on another potential wild card in the GOP presidential race. Apparently former Senator Fred Thompson (R-Tennessee) -- most recently of "Law & Order" fame -- is "exploring seriously" a bid for the GOP nomination.

Core Questions on DOT Story Remain Unanswered

There are some questions arising in the last few days about DOT secretary Frank Busalacchi's decision to send state attorneys to help resolve out-of-state tax disputes regarding Dennis Troha's trucking firms.

It's no surprise that this is being made into a political issue. It seems reasonable enough to believe that at least part of the reason the attorneys were sent is because of Troha's donations to the Doyle campaign.

After all, the last trucking firm known to get this type of treatment was Schneider National in 2001, when the state sent attorneys to Georgia to settle an out-of-state tax dispute for the Green Bay trucking giant.

And a quick look at campaign finance records shows that Schneider CEO Donald Schneider has been a major donor to Tommy Thompson, Scott McCallum, and a number of other GOPers since the 1990s (although the JS, WSJ, and other news outlets haven't seemed to notice that, yet).

McCallum, of course, was governor when the state sent an attorney to Georgia in 2001 to help settle Schneider's tax dispute, though much of the administration was probably still Tommy's, who would've just left in January of that year to become DHHS secretary.

It would be little surprise to me that the Schneider donations to Thompson/McCallum or those made to the Doyle campaign by Troha impacted the decision to send state attorneys to settle the out-of-state tax disputes. Any major business in the state is surely going to get heard on some level by the administration regardless, but I bet a little donor love can go a long way toward cutting through some of the red tape that otherwise might exist.

And a big wild card for the issue of whether anything blatantly improper was done is something mentioned in a WSJ article yesterday (emphasis mine):

Trucking companies pay taxes on the fuel purchased for their vehicles in various states as they drive across the country. Under a multistate compact, the home state for a given company, in this case Wisconsin, is responsible for auditing company reports and making sure the correct amount of taxes goes to each state in which the trucks are operating.

It seems to me that this multistate compact is a pretty big piece of the puzzle. WKOW in Madison also noted the compact, called the International Fuel Tax Agreement (IFTA), in a recent story, but important questions still remain.

What are the specific expectations for states participating in this compact when disputes arise? Do those expectations entail sending state resources out-of-state? Has any other state sent resources to Wisconsin or another state in the compact to help settle disputes? Has a company ever been denied state services pertaining to the compact? These are all rational questions, and I'm sure there are others, that our media should be answering.

The IFTA section on the DOT website gets the ball rolling on the basics of the compact, but more pertinent info on the issue of resolving disputes surely could be gained through a minimal amount of media digging.

Instead, much of the media has opted to engage in more speculation over the issue -- such as whether it's right for the state Senate to proceed with confirmation hearings for Busalacchi next Tuesday -- rather than spending time finding answers to the core questions of the story.

A cynic would almost think some media outlets believe it's more beneficial to leave those core questions unanswered -- stories about them are not nearly as enticing.

"Soviet-Style" Health Care

Caught in the midst of a Cold War time warp, Manitowoc County exec and state Rep. Bob Ziegelbauer (D-Manitowoc) had this to say the other day regarding health care reform in Wisconsin: "Do we want Soviet-style central planning, or do we trust individuals to make their own health care decisions. It's really that simple."

Didn't he get the memo? The terrorists are the enemy now.

Observe the difference: "Do we want al Qaeda-style sleeper cell planning, or do we trust individuals to make their own health care decisions. It's really that simple."

See what I mean? Much scarier, especially for the post-perestroika under 35 crowd, yet only equally as ridiculous.

(Side-Note: The Manitowoc Herald Times Reporter didn't put a question mark after the first sentence of Ziegelbauer's statement, which means it's either a typo or it was pretty clear to the reporter that the county exec/state rep really wasn't asking a question.)

Ziegelbauer went on to note that he's always urging his Mantiowoc County employees to sign-up for HSAs to save the county money and help them to be the best health care consumers they can be.

No word on whether Ziegelbauer realizes that one of the "Soviet-style central planning" bills before the state legislature proposes the use of HSAs statewide, or whether Ziegelbauer himself forgoes the comprehensive health care plan he's afforded through either of his public positions to sign up for a HSA.

Campus Merger or Bust

I can understand why Waukesha County exec Dan Vrakas is upset that the UWM and UW-Waukesha merger idea is losing steam. After all, if the two merge, the state will assume the entire cost, relieving Vrakas of the operations bill along with facility debt payments that the county currently pays for UW-Waukesha.

But it's a little more curious to see new Assembly Colleges and Universities chairperson Steve Nass (R-Whitewater) raising a stink over the sinking of the merger idea.

"There's got to be other information available," Nass exclaimed in response to a UW System report that showed a full campus merger would cost twice as much as the university center idea.

Maybe the WPRI is available. (Side-Note: Do you suppose the GOP has a special signal and red phone just like the Gotham City Police Department for these occasions?)

But, the fact is, there just isn't going to be a way to crunch the numbers so that transforming a 2-year campus into a 4-year campus -- whether or not it happens under the guise of a merger -- is cheaper than simply creating upper division instructional capabilities at UW-Waukesha, which is essentially the university center option.

Under the university center option, the state would assume the cost of upper-division and graduate programming, which includes the construction and maintenance of any new buildings used by the university center, but Waukesha County would continue to pick up the full facilities tab for existing infrastructure. That alone is a huge cost difference between the university center and merger options.

Add to that the fact that instituting a full 4-year campus and graduate school would involve hiring more full-time professors -- currently the UW Colleges rely heavily on part-time instructors -- along with developing a research and technology presence and bringing on board administrative staff to provide resources for students as they navigate through their programs and beyond.

In short, it's pretty obvious why the merger cost is more than the university center option. And it really isn't even all that close.

But there's more to the story for Nass. Last August he wrote an op-ed published at WisOpinion in which he laid out his vision for the UW System. One of the sections involved a proposal to merge all of the UW Colleges campuses with the Wisconsin Technical College System. Setting aside the problems involved in merging two major entities with clearly different missions, there seems to be inherent in the proposal a belief that mergers always equal less cost.

And insomuch that mergers accompany downsizing or even, to a lesser extent, just the maintenance of existing services, this belief in the cost saving potential of consolidation can be accurate. But there are few people -- and even fewer businesses -- who are interested in downsizing the public postsecondary options in the state; indeed, all of the options involving UWM and UW-Waukesha entail expansion, not merely consolidation.

I don't want to jump to any firm conclusions about Nass' reasoning for trying to get around the findings of a sound study, but the belief that you can always get more from less seems to be a logical culprit. To be sure, some of Nass' GOP colleagues on the Assembly Colleges and Universites Committee have expressed that exact belief regarding the merger idea.

State Rep. Rich Zipperer (R-Pewaukee) has said that not only should expanding UW-Waukesha into a 4-year campus not cost more than establishing a university center there, it should actually save the state money on the whole.

This isn't to say that important efficiencies can't be realized within an institution. In my job at UWM, in fact, I'm working on a number of projects aimed at doing more -- or at least as much -- administratively with less through automating previously manual processes.

But when you're talking about the entirety of an institution that's as service-centered and geographically-fixed as a university campus, there's just no way to do more at the same level of quality on less, and that goes for private institutions as well as public.

If proponents of the merger idea want to continue to push for it, that's certainly fine. I really don't have a strong opinion on it either way (my inclination is to start with the university center and work from there if more is needed). But they need to accept the fact that a full merger is among the most expensive options, not the least.

Ideologically Limiting Health Care Reform

In the Journal Sentinel on Sunday, CEO and business columnist John Torinus wrote about the growing consolidation of health care providers in the Milwaukee area.

With ProHealth Care getting set to buy Medical Associates and the other major players looking to buy Advanced Healthcare, the trend toward consolidation on the provider side is unmistakable.

What's interesting about the column by Torinus is that he frames these mergers as anti-capitalist. He writes that to defend such a trend "[defies] classic economic theory that extols competition, not consolidation."

But what this ignores is that the mergers themselves are a direct result of competition on the supply side of the market, which isn't aimed at preserving consumer choice, but rather is an attempt by each supplier to ensure that it's the one consumers choose. If that ends up happening because it's the only choice consumers can choose, then all the better.

Unwilling to propose government intervention that would either break up the developing provider monopolies or, better yet, consolidate the payer side to match the providers in size and power, Torinus is left to recommend that consumers tinker around the edges of the provider giants like individual pesky gnats.

These recommendations center on the idea of backing retail health care endeavors that offer a limited array of pre-packaged and routine services that are paid in cash, not through insurance. This type of health care, while important, isn't the type that's going to make the major providers take notice.

For starters, many of the big providers also own many of the retail health care centers that are popping up around the Milwaukee area and elsewhere. In fact, Aurora Health Care -- the biggest and most profitable provider in the state...and counting -- already operates almost twenty cash-based "QuickCare" centers around the metro area in places like Piggly Wiggly, Brookfield Square Mall, Southridge Mall, and a number of Wal-Marts. And after your ailment is diagnosed at the QuickCare center, you can head off to one of Aurora's growing number of retail pharmacies to fill your prescription. Now that's some synergy.

Secondly, even if some independent provider groups can carve out a niche in areas like standalone MRIs or vaccinations, the impact they will have on giants like Aurora will hardly amount to a lone paper cut at best.

There is certainly nothing wrong with retail health care, assuming it remains linked to routine services that it can handle responsibly, nor is there anything inherently wrong with using individualized consumerism to keep providers in check.

But the fact is that by themselves, these measures will never match up to the massive consolidation that's taking place on the provider side, nor will they satisfy the growing need and desire for signficant health care reform across the state and country.

In a recent NY Times/CBS poll, for instance, more people pointed to health care as the most important domestic issue than immigration, traditional values, and reducing taxes combined, and 9 out of 10 respondents said that the American health system needs either fundamental reform or complete rebuilding; minor changes was the choice of only 8 percent.

Now is clearly not the time to let our options for solving the growing health care crisis become limited by ideology.

The Troha Indictment: It's the Institution, Stupid

Allow me to get out of the way up front that I'm not happy about Doyle's acceptance of campaign funds from Dennis Troha's family members. I think the campaign knew all of the money was really from daddy and not any of the kids.

But I don't think there's going to be any evidence to actually convict Doyle or any of his top campaign staffers of wrongdoing. And setting aside that legal question, as Brian Fraley points out, it's the court of public opinion that most politicians need to consider first and foremost when news like this hits.

In many ways, the standard for conviction in the court of public opinion is lower than in a court of law. There are rules and regulations in a courtroom that don't exist in the realm of public discourse. And courts of law are presided over by judges who often have a level of respect for fairness and equity, while the court of public opinion is presided over by the media that is -- more and more, as a recent Frontline series pointed out -- after an eye-catching and, subsequently, money-making headline.

That said, my guess is that this story will have little to no political impact on Governor Doyle. And that has nothing to do with Doyle himself, but rather the Office of Governor in the State of Wisconsin.

After Doyle beat Mark Green in November -- so much so that the GOP didn't even bother using Doyle's cash advantage as an excuse -- many conservatives in the state were at a loss for words to explain why. Indeed, Doyle had been hit and hit hard for months on ethical questions.

I had conservative commenters showing up on nearly all of my election-related posts from last spring on telling me to "just wait until November" when Georgia Thompson and all of the other messes thrown at Doyle would finally hit the fan (and I'm sure I'll get the same about Troha).

And the Journal Sentinel easily has enough coverage of its own to dedicate a special section on its website to all of the front page stories it ran against the governor.

But not only did Doyle greatly expand his margin of victory from 2002 across the state, as Jay pointed out shortly after the election, the governor went from losing the 5-county Milwaukee area to McCallum in 2002 to winning it in 2006. That means in spite of the incessant JS attacks, Doyle actually picked up votes in the area where the paper is most widely read.

And this isn't to say that Wisconsin voters don't care about ethics, as some conservatives assumed after the election. Rather, most simply see it as part and parcel of the institution of governor in the state. For most, ethics was going to be just as questionable under Green as it was under Doyle. In short, ethics was a wash.

To be sure, does anyone think that Troha and others who skirt campaign laws would simply stop donating to the Wisconsin governor in the event that Green won the election? People can talk all day about how Green is a "good guy," and I'm sure he is. After seeing his webmercial where he played basketball with his kids out in the driveway, I thought he seemed like a pretty good guy myself.

But, again, ethical questions are not as much about the person as they are the institution. Green didn't talk at all about how he'd change the institution of governor in Wisconsin, and so voters were left to believe -- and I'd say rightfully so -- that he wouldn't have changed it.

For more evidence, take a look at who Dennis Troha was giving his money to between 1991 and 2000: Tommy G. Thompson.

Of course, ethical bombshells that dominate even TV news -- where most people get their info these days -- can play a role in the outcome of gubernatorial elections, but as riled up as conservatives got over Georgia Thompson and as riled up as they'll get over Dennis Troha, those stories simply don't constitute bombshells in the general public's eye.

To put it bluntly, the bar for what constitutes an ethical bombshell for governors in Wisconsin is so high because the bar for public expectations of gubernatorial ethics is so low.

So where does that leave us? For me, it's about getting back to the point where the ethical expectations for the governor in Wisconsin aren't at the basement level.

Wiggy argues that the issue is about the play side of pay-for-play. He writes:

With the news of the Dennis Troha brouhaha, we have yet another reminder that if we really want clean elections without campaign contributors trying to buy influence, then the surest way would be to remove the power of the state to reward campaign contributors. Putting the governor as the main arbiter in handing out casino licenses is just an invitation for abuse.

I just don't see a solution there. After all, the issue is not simply about the governor's control over casino licenses. Even if stronger checks were given to the legislature on that issue, it may disburse the level of stink by spreading out the donor love to more legislators, but the process as a whole would still stink just as much.

And this issue isn't just about casinos. It's a problem that pervades public policymaking. Unless the plan is to stop elected officials from setting public policy -- in other words, doing their job -- then no amount of futzing with the legislative process in relation to the campaign donation process is going to change the fact that elected officials are accountable first and foremost to those who help their chances at re-election the most. That is, those who give them the most amount of money.

The solution, rather, is to focus on the pay side of pay-for-play. If politicians are going to be accountable first and foremost to their donors and the goal is to make them accountable first and foremost to the public, then you need to make the public their donors, plain and simple.

Elections and the representatives that are created by them are public entities, and they should be funded that way.

UPDATE: The Recess Supervisor nails it, as usual.

Van Hollen May Get What He Asks For

The state crime lab has been a major issue since the AG race last year. At the heart of the issue is what's been called "the CSI effect," which is the desire of juries to see hard scientific evidence in order to convict a defendant, just as it happens on our television sets.

Reports are that requests to the crime lab are up 85 percent since 2003, which, perhaps not so coincidentally, is about the same time CSI hit #1 in the ratings.

J.B. Van Hollen has already come under some heat regarding the crime lab backlog when his tune changed quickly after taking the AG office in January.

During the election, Van Hollen confidently told voters he could find funds within the existing DOJ budget to handle the backlog. Once he actually became AG, Van Hollen altered his statement to say that it would take 20 months to clear up the backlog with existing resources at the DOJ -- and that's if no other requests are made during that time.

In early February, Governor Doyle announced that his budget would include the addition of 15 positions for the crime lab, following through on a campaign pledge he made. Van Hollen quickly said that, although the 15 positions would help, they weren't enough.

A couple of weeks later, Van Hollen announced that 31 new positions would be required -- twice what the governor proposed -- and that if he got them, he could have the crime lab backlog eliminated by 2010.

Just yesterday, the Joint Finance Committee said ok -- if 31 new hires is what he needs, then 31 new hires is what he'll get.

Good news, yes, but if it's approved by the full legislature and the governor, that means Van Hollen is effectively on the clock to have the backlog eliminated by 2010, which also just so happens to be his reelection year. A double-edged sword, indeed.

After all, it's not just that a backlog exists, it's that it's increasing each and every year as more requests poor in. Van Hollen is saying that the staffing he has at the start of FY 2007-2008 will be enough to eliminate the existing backlog and prevent another one from developing between now and the start of FY 2010-2011.

That's quite a promise. And, as Peg Lautenschlager demonstrated last September, one term in office is hardly enough time to coast into reelection, even within your own party's nomination. To be sure, in the midst of the election season last July, almost half of the state still didn't even know enough about Lautenschlager to have an opinion about her, in spite of the fact that she was the state's AG for the past three and a half years.

The big wild card for Van Hollen is his plan to put the reins (see comment) on the number of requests prosecutors make for evidence analysis from the crime lab. Of course, the requests aren't simply a result of prosecutors willy-nilly sending samples off to Madison; they're being driven by jury expectations that scientific evidence exists for a conviction.

The real trick is going to be limiting requests without compromising the outcome of state cases, and it seems likely that defense attorneys are going to learn to become keenly aware of how to play the cases that don't make the cut for crime lab analysis.

It sounds like a lot of risky business for a first term AG. Perhaps a better line would've been to say that with the 31 new positions, the backlog would be trimmed down to a manageable to nonexistent level that also ensures all cases that require scientific analysis of evidence will get it.

That line wouldn't come without political heat emanating from the promises made during the campaign, but that heat would mostly come now, four years before his re-election, rather than in the midst of the re-election race four years from now, which is when the promise to fully eliminate the backlog will need to be realized.

Besides, the campaign promise to end the backlog through existing DOJ resources has already been broken. Why create a new one to deal with during the next campaign? Now seems to be the time to start laying up rather than continuing to go straight for the pin.

But, now that the promise has been made publicly, we'll need to wait until 2010 to see how it pans out for the new AG; assuming, that is, Van Hollen actually gets what he asks for.

UPDATE: Here is Van Hollen's response to the JFC approval of the 31 new positions. He curiously refers to the elimination of the backlog by 2010 as a "goal" -- and he does so twice. Not a promise or pledge, but a goal.

Here's the line from the AP story on Van Hollen's request to legislators for the 31 new positions exactly two weeks ago (emphasis mine):

But Van Hollen, a Republican, wants authorization in the adjustment bill for 31 new hires, including 29 analysts. If he can get them on board by July 1, he can eliminate the backlog by 2010, he told the Assembly judiciary and criminal justice committees.

Before it was something he can and -- as a corollary -- would do, now it's just something he wants to accomplish.